title: Uninformed consent: Do medicine residents lack the proper framework for code status discussions?
abstract: BACKGROUND
  Conversations eliciting patient preferences about cardiopulmonary resuscitation (CPR) are among the most common examples of informed consent. However, this is rarely recognized and therefore may not include all key elements of informed consent, namely, details and benefits of the procedure, significant risks involved, likelihood of the outcome, and alternative therapeutic options.
  
  
  OBJECTIVE
  Assess the content of code status discussions as reported by residents to examine whether residents meet requirements of informed consent.
  
  
  METHODS
  Prospective, observational, single-center survey study.
  
  
  METHODS
  Internal medicine residents at an academic medical center.
  
  
  METHODS
  Medicine residents were surveyed and data were anonymously collected.
  
  
  METHODS
  Content of code status discussions and knowledge of CPR outcomes.
  
  
  RESULTS
  Among 100 respondents, 66% have code status discussions with most patients upon hospital admission. Two main barriers to discussing code status were lack of time (49%) and lack of rapport (29%). Only 8% reported discussing all 5 elements of informed consent. Less than 10% of the residents correctly answered questions testing knowledge regarding outcomes after cardiac arrest. In logistical regression analyses, residents who included all key elements of informed consent reported more confidence that they provided the information needed for patients to make an informed decision (odds ratio 1.7 [95% confidence interval: 1.2-2.3]).
  
  
  CONCLUSIONS
  Resident conversations regarding CPR are insufficient in the 5 key elements of informed consent. Framing code status discussions as examples of informed consent may be an effective strategy for educating residents or may improve the quality of these discussions, potentially leading to better patient decisions.
authors.affiliation: Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Adam F
authors.initials: AF
authors.lastname: Binder
authors.affiliation: Hospitalist Program, Beth Isreal Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Grace C
authors.initials: GC
authors.lastname: Huang
authors.affiliation: Ambulatory Palliative Care Services, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Buss
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003142:Communication; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D010817:Physician-Patient Relations; D011446:Prospective Studies; D016414:Resuscitation Orders