Use of a standardized code status explanation by residents among hospitalized patients.
OBJECTIVE
There is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.


METHODS
This was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.


RESULTS
The composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.


CONCLUSIONS
The scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.


CONCLUSIONS
Standardized discussion of code status and training in communication of end-of-life care merit further research.
Cleveland Clinic, Cleveland, OH, USA.
Kriti
K
Mittal
Division of Hospital Medicine, Brown University, Providence, RI, USA.
Kapil
K
Sharma
Department of Neurology, Columbia University, New York, NY, USA.
Neha
N
Dangayach
St Elizabeth's Medical Center, Boston, MA, USA.
Dhaval
D
Raval
Department of Obstetrics and Gynecology, University of Massachusetts, Worcester, MA, USA.
Katherine
K
Leung
Saint Vincent Hospital, Worcester, MA, USA.
Susan
S
George
Saint Vincent Hospital, Worcester, MA, USA.
George
G
Abraham
Code status; cardiopulmonary resuscitation; end-of-life discussion; physician–patient communication