NEJM Evid. 2025 May;4(5):EVIDoa2400422. doi: 10.1056/EVIDoa2400422. Epub 2025 Apr 22.
ABSTRACT
BACKGROUND: The effect of a shared decision-making approach on patients’ code status decisions remains unknown. We compared an approach for shared decision-making with usual care to evaluate the effect on patients’ code status preferences and quality of decision-making.
METHODS: In a pragmatic cluster-randomized controlled trial conducted in six teaching hospitals in Switzerland, we randomly assigned residents to conduct code status discussions based on either an approach incorporating didactic teaching, observation, and feedback and a shared decision-making checklist with a decision aid, or usual care. The primary end point was patients choosing a do-not-resuscitate (DNR) code status in the event of a cardiac arrest. The key secondary end point was patients’ decisional uncertainty, measured by the Decisional Conflict Scale (range 0 to 100, with lower scores indicating lower decisional uncertainty).
RESULTS: A total of 206 residents caring for 2663 medical patients were included in the trial. Compared with patients in the usual care group, patients in the intervention group had a significantly higher frequency of choosing DNR as their code status (685/1370 (50.0%) vs. 481/1293 (37.2%); adjusted risk ratio, 1.37 (95% confidence interval, 1.25 to 1.50); P<0.001). The intervention was associated with lower decisional uncertainty (Decisional Conflict Scale score, 14.4±15.3 vs. 21.8±20.2 points; adjusted difference, -7.06 (95% confidence interval, -9.43 to -4.68).
CONCLUSIONS: An approach for shared decision-making that included the discussion of expected outcomes had a significant influence on the code status of medical patients, with a higher preference for DNR code status, and was associated with less uncertainty around the decision. (Funded by the Swiss National Science Foundation and the Swiss Society of General Internal Medicine; ClinicalTrials.gov number, NCT03872154.).
PMID:40261118 | DOI:10.1056/EVIDoa2400422
Authors: Christoph Becker, Sebastian Gross, Katharina Beck, Simon A Amacher, Alessia Vincent, Jonas Mueller, Nina Loretz, Rene Blatter, Chantal Bohren, Tabita Urben, Armon Arpagaus, Rainer Schaefert, Philipp Schuetz, Nina Kaegi-Braun, Lena Stalder, Jörg D Leuppi, Drahomir Aujesky, Christine Baumgartner, Balthasar Hug, Hannah Schmieg, Valentina Delfine, Thomas Peters, Arnoud J Templeton, Stefano Bassetti, Sabina Hunziker
Published: 2025-04-22 10:00:00
Read the full article: View on PubMed
