title: Patient-physician communication about code status preferences: a randomized controlled trial.
abstract: BACKGROUND
  Code status discussions are important in cancer care, but the best modality for such discussions has not been established. The objective of this study was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients' do-not-resuscitate (DNR) preference.
  
  
  METHODS
  Patients in a supportive care clinic watched 2 videos showing a physician-patient discussion regarding code status. Both videos were identical except for the ending: one ended with the physician asking for the patient's code status preference and the other with the physician recommending DNR. Patients were randomly assigned to watch the videos in different sequences. The main outcome was the proportion of patients choosing DNR for the video patient.
  
  
  RESULTS
  A total of 78 patients completed the study, and 74% chose DNR after the question video, whereas 73% chose DNR after the recommendation video. Median physician compassion score was very high and not different for both videos. All 30 of 30 patients who had chosen DNR for themselves and 30 of 48 patients who had not chosen DNR for themselves chose DNR for the video patient (100% versus 62%). Age (odds ratio = 1.1/year) and white ethnicity (odds ratio = 9.43) predicted DNR choice for the video patient.
  
  
  CONCLUSIONS
  Ending DNR discussions with a question or a recommendation did not impact DNR choice or perception of physician compassion. Therefore, both approaches are clinically appropriate. All patients who chose DNR for themselves and most patients who did not choose DNR for themselves chose DNR for the video patient. Age and race predicted DNR choice.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.forename: Pedro
authors.initials: P
authors.lastname: Perez-Cruz
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.forename: Walter
authors.initials: W
authors.lastname: Baile
authors.forename: Eva
authors.initials: E
authors.lastname: Chittenden
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D016223:Advance Directives / Q000941:ethics / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D010817:Physician-Patient Relations; D016414:Resuscitation Orders / Q000941:ethics / Q000523:psychology*
references.citation: Oncology (Williston Park). 1999 Jul;13(7):1021-31; discussion 1031-6, 1038
references.pmid: 10442349
references.citation: Am J Respir Crit Care Med. 2005 May 1;171(9):987-94
references.pmid: 15665319
references.citation: J Clin Oncol. 2010 Jan 10;28(2):299-304
references.pmid: 19933909
references.citation: J Clin Epidemiol. 1992 Sep;45(9):941-50
references.pmid: 1432023
references.citation: Resuscitation. 2006 Nov;71(2):152-60
references.pmid: 16987581
references.citation: Cancer. 2010 Jun 15;116(12):3061-70
references.pmid: 20564412
references.citation: J Crit Care. 2009 Jun;24(2):288-92
references.pmid: 19327289
references.citation: Respir Care. 2000 Nov;45(11):1385-94; discussion 1394-8
references.pmid: 11063526
references.citation: Eur J Cancer Care (Engl). 2006 Sep;15(4):371-8
references.pmid: 16968320
references.citation: Psychooncology. 1998 Nov-Dec;7(6):502-7
references.pmid: 9885091
references.citation: J Am Geriatr Soc. 2004 Jan;52(1):51-8
references.pmid: 14687315
references.citation: Gerontologist. 2005 Oct;45(5):634-41
references.pmid: 16199398
references.citation: Biometrics. 1965 Jun;21:467-80
references.pmid: 14338679
references.citation: J Med Ethics. 2000 Oct;26(5):396-9
references.pmid: 11055046
references.citation: Arch Intern Med. 2005 Aug 8-22;165(15):1705-12
references.pmid: 16087817
references.citation: Oncologist. 2009 Oct;14(10):1039-49
references.pmid: 19808772
references.citation: J Pain Symptom Manage. 2005 May;29(5):489-97
references.pmid: 15904751
references.citation: Eur J Cancer. 2011 Aug;47(12):1863-72
references.pmid: 21514818
references.citation: Eur J Cancer Care (Engl). 2011 Jan;20(1):56-61
references.pmid: 20148936
references.citation: Am J Med. 2010 Jan;123(1):4-9
references.pmid: 20102982
references.citation: Med Care. 2000 Mar;38(3):335-41
references.pmid: 10718358
references.citation: Support Care Cancer. 2006 Jan;14(1):30-7
references.pmid: 15937688
references.citation: J Public Health Med. 2001 Sep;23(3):227-34
references.pmid: 11585196
references.citation: Curr Opin Crit Care. 2007 Oct;13(5):482-8
references.pmid: 17762223
references.citation: Palliat Med. 2007 Sep;21(6):501-5
references.pmid: 17846090
references.citation: J Clin Oncol. 2011 Sep 10;29(26):3547-52
references.pmid: 21844494
references.citation: J Gen Intern Med. 1996 Nov;11(11):651-6
references.pmid: 9120650
references.citation: Palliat Med. 2006 Jun;20(4):397-406
references.pmid: 16875109
references.citation: J Clin Oncol. 2007 Nov 20;25(33):5275-80
references.pmid: 18024875
references.citation: J Gen Intern Med. 2010 Feb;25(2):150-3
references.pmid: 19894078
references.citation: Cancer. 2000 May 1;88(9):2164-71
references.pmid: 10813730
references.citation: J Clin Oncol. 2010 Jan 10;28(2):305-10
references.pmid: 19949010
references.citation: J Clin Oncol. 2001 Jun 1;19(11):2883-5
references.pmid: 11387361
references.citation: Psychooncology. 2001 Sep-Oct;10(5):436-43
references.pmid: 11536422
references.citation: J Clin Oncol. 1999 Jan;17(1):371-9
references.pmid: 10458256
references.citation: Pain. 1989 May;37(2):203-209
references.pmid: 2748193
references.citation: Support Care Cancer. 2000 Nov;8(6):472-8
references.pmid: 11094992
references.citation: Arch Intern Med. 2000 Mar 27;160(6):786-94
references.pmid: 10737278
references.citation: J Am Med Dir Assoc. 2005 Jan-Feb;6(1):18-21
references.pmid: 15871866
references.citation: JAMA. 1996 Aug 14;276(6):496-502
references.pmid: 8691562
references.citation: Support Care Cancer. 2005 Oct;13(10):842-9
references.pmid: 15846524
references.citation: Ann Oncol. 1999 Jan;10(1):39-46
references.pmid: 10076720
references.citation: Psychosomatics. 2004 Mar-Apr;45(2):119-28
references.pmid: 15016925