Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

TY - JOUR

T1 - Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

AU - Saltbaek, Lena

AU - Michelsen, Hanne M

AU - Nelausen, Knud M

AU - Gut, Rikke

AU - Nielsen, Dorte L

PY - 2013/12

Y1 - 2013/12

N2 - Background: The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated. Purpose: The purpose of this study was to determine the impact of different patient characteristics on the following outcomes: (1) patients' wishes for or against CPR, (2) assessments made by physicians of the indication for CPR, and (3) the probability of discordance between patients' wishes and physicians' assessments. Methods: In this survey, 1,128 of 1,408 cancer patients received a questionnaire concerning their wish for CPR. In total, 904 patients responded. A total of 61 treating physicians assessed the medical indication for resuscitation. Different predefined patient characteristics were analyzed using both univariate and multivariate analyses. Results: Ninety percent of responding patients wished to receive CPR. The physicians found indications supporting CPR in 89 % of patients. Age ≥70 years, increasing line of treatment, poor prognosis, living alone, and poor self-rated physical and mental health enhanced both patients' wishes and physicians' assessments to withhold CPR. However, only age ≥70 years, poor prognosis, and poor self-rated physical health significantly predicted rejection of CPR in multivariate analyses. The likelihood of discordance between patients and physicians was significantly higher when the patient was ≥70 years and when the expected 5-year survival was <25 %. Conclusions: Factors associated with the imminence of dying influenced both patients and physicians to refrain from CPR, and perhaps more surprisingly, the probability of discordance between patients and physicians increased.

AB - Background: The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated. Purpose: The purpose of this study was to determine the impact of different patient characteristics on the following outcomes: (1) patients' wishes for or against CPR, (2) assessments made by physicians of the indication for CPR, and (3) the probability of discordance between patients' wishes and physicians' assessments. Methods: In this survey, 1,128 of 1,408 cancer patients received a questionnaire concerning their wish for CPR. In total, 904 patients responded. A total of 61 treating physicians assessed the medical indication for resuscitation. Different predefined patient characteristics were analyzed using both univariate and multivariate analyses. Results: Ninety percent of responding patients wished to receive CPR. The physicians found indications supporting CPR in 89 % of patients. Age ≥70 years, increasing line of treatment, poor prognosis, living alone, and poor self-rated physical and mental health enhanced both patients' wishes and physicians' assessments to withhold CPR. However, only age ≥70 years, poor prognosis, and poor self-rated physical health significantly predicted rejection of CPR in multivariate analyses. The likelihood of discordance between patients and physicians was significantly higher when the patient was ≥70 years and when the expected 5-year survival was <25 %. Conclusions: Factors associated with the imminence of dying influenced both patients and physicians to refrain from CPR, and perhaps more surprisingly, the probability of discordance between patients and physicians increased.

U2 - 10.1007/s00520-013-1916-2

DO - 10.1007/s00520-013-1916-2

M3 - Journal article

C2 - 23925557

SN - 0941-4355

VL - 21

SP - 3363

EP - 3370

JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

IS - 12

ER -