Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis.
Journal
JAMA network open
ISSN: 2574-3805
Titre abrégé: JAMA Netw Open
Pays: United States
ID NLM: 101729235
Informations de publication
Date de publication:
05 06 2019
05 06 2019
Historique:
entrez:
8
6
2019
pubmed:
8
6
2019
medline:
19
2
2020
Statut:
epublish
Résumé
Whether specific communication interventions to discuss code status alter patient decisions regarding do-not-resuscitate code status and knowledge about cardiopulmonary resuscitation (CPR) remains unclear. To conduct a systematic review and meta-analysis regarding the association of communication interventions with patient decisions and knowledge about CPR. PubMed, Embase, PsycINFO, and CINAHL were systematically searched from the inception of each database to November 19, 2018. Randomized clinical trials focusing on interventions to facilitate code status discussions. Two independent reviewers performed the data extraction and assessed risk of bias using the Cochrane Risk of Bias Tool. Data were pooled using a fixed-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported. The study was performed according to the PRISMA guidelines. The primary outcome was patient preference for CPR, and the key secondary outcome was patient knowledge regarding life-sustaining treatment. Fifteen randomized clinical trials (2405 patients) were included in the qualitative synthesis, 11 trials (1463 patients) were included for the quantitative synthesis of the primary end point, and 5 trials (652 patients) were included for the secondary end point. Communication interventions were significantly associated with a lower preference for CPR (390 of 727 [53.6%] vs 284 of 736 [38.6%]; RR, 0.70; 95% CI, 0.63-0.78). In a preplanned subgroup analysis, studies using resuscitation videos as decision aids compared with other interventions showed a stronger decrease in preference for life-sustaining treatment (RR, 0.56; 95% CI, 0.48-0.64 vs 1.03; 95% CI, 0.87-1.22; between-group heterogeneity P < .001). Also, a significant association was found between communication interventions and better patient knowledge (standardized mean difference, 0.55; 95% CI, 0.39-0.71). Communication interventions are associated with patient decisions regarding do-not-resuscitate code status and better patient knowledge and may thus improve code status discussions.
Identifiants
pubmed: 31173119
pii: 2735460
doi: 10.1001/jamanetworkopen.2019.5033
pmc: PMC6563579
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e195033Commentaires et corrections
Type : CommentIn
Références
J Gen Intern Med. 1995 Aug;10(8):436-42
pubmed: 7472700
Ann Intern Med. 1999 May 4;130(9):772-4
pubmed: 10357697
Crit Care Med. 2015 Mar;43(3):621-9
pubmed: 25479118
J Gen Intern Med. 2011 Apr;26(4):359-66
pubmed: 21104036
J Palliat Med. 2013 Jun;16(6):623-31
pubmed: 23725233
Emerg Med J. 2012 Jan;29(1):3-5
pubmed: 22045608
J Gen Intern Med. 2008 Nov;23(11):1877-82
pubmed: 18800206
JAMA. 1995 Nov 22-29;274(20):1591-8
pubmed: 7474243
J Clin Oncol. 2013 Sep 20;31(27):3403-10
pubmed: 23897967
Crit Care Med. 2004 May;32(5):1149-54
pubmed: 15190965
J Hosp Med. 2017 Sep;12(9):700-704
pubmed: 28914272
Med J Aust. 1999 Sep 6;171(5):239-42
pubmed: 10495754
J Clin Oncol. 2013 Jan 20;31(3):380-6
pubmed: 23233708
Acad Med. 2009 Nov;84(11):1533-9
pubmed: 19858811
Resuscitation. 2015 Mar;88:99-113
pubmed: 25433293
Crit Care. 2014 Nov 18;18(6):604
pubmed: 25403291
Cancer. 2017 Dec 15;123(24):4895-4902
pubmed: 28881383
JAMA. 1996 Feb 14;275(6):474-8
pubmed: 8627970
PLoS One. 2016 Feb 25;11(2):e0150214
pubmed: 26913753
Circulation. 2016 Jul 5;134(1):52-60
pubmed: 27358437
Lancet. 2010 Oct 16;376(9749):1347-53
pubmed: 20934213
QJM. 2018 Aug 1;111(8):549-554
pubmed: 29860409
Resuscitation. 2008 Dec;79(3):490-8
pubmed: 18990479
Crit Care Med. 2000 Aug;28(8):3044-9
pubmed: 10966293
Cancer. 2013 Jun 1;119(11):2067-73
pubmed: 23564395
Chest. 2005 Jun;127(6):2188-96
pubmed: 15947336
Curr Opin Support Palliat Care. 2011 Dec;5(4):312-6
pubmed: 21897257
Crit Care Med. 2010 Jan;38(1):101-8
pubmed: 19770741
Ann Intern Med. 1998 Sep 15;129(6):441-9
pubmed: 9735081
J Pain Palliat Care Pharmacother. 2004;18(1):87-109
pubmed: 15148012
J Gen Intern Med. 2015 Aug;30(8):1071-80
pubmed: 25691237
PLoS One. 2017 Nov 2;12(11):e0187375
pubmed: 29095938
Resuscitation. 2014 Nov;85(11):1418-31
pubmed: 25195071
J Hosp Med. 2006 May;1(3):161-7
pubmed: 17219490
J Clin Oncol. 2010 Jan 10;28(2):305-10
pubmed: 19949010
Health Law Can. 1984;4(4):103-7
pubmed: 10310688
J Palliat Med. 2012 Jul;15(7):805-11
pubmed: 22559905
J Gen Intern Med. 1999 Sep;14(9):559-63
pubmed: 10491246
Resuscitation. 2012 Nov;83(11):1305-6
pubmed: 22955050
JAMA. 1991 Apr 10;265(14):1868-71
pubmed: 2005737
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
J Am Geriatr Soc. 2012 May;60(5):946-50
pubmed: 22458336
J Am Geriatr Soc. 1997 Apr;45(4):526-7
pubmed: 9100727
Int J Gen Med. 2018 Feb 12;11:73-77
pubmed: 29491715
J Community Hosp Intern Med Perspect. 2014 Apr 14;4:
pubmed: 24765258
J Am Geriatr Soc. 2000 May;48(S1):S187-93
pubmed: 10809474
J Palliat Med. 2015 Jun;18(6):535-41
pubmed: 25984641
N Engl J Med. 1996 Jun 13;334(24):1578-82
pubmed: 8628340
Int J Surg. 2010;8(5):336-41
pubmed: 20171303