Palliative Care and End of Life Issues |

When Terminal Illness Is Worse Than Death: A Multicenter Study of Healthcare Providers' Resuscitation Desires FREE TO VIEW

Luis Chavez, MS; Karen Torres, MS; Maria Duarte, MS; Salim Surani, MD; Sharon Einav, MD; Joseph Varon, MD
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University General Hospital, Houston, TX

Chest. 2015;148(4_MeetingAbstracts):771A. doi:10.1378/chest.2270928
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SESSION TITLE: Palliative Care and End of Life Issues Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: We have previously described the resuscitation preferences of health care providers in relation to their level of training. There is no data on the effect of terminal illness on these preferences.

METHODS: After obtaining Institutional Review Board approval, we conducted a self-administered survey in 9 health-care institutions located in 4 geographical regions in North and Central America. An anonymous (33 questions) questionnaire was applied to staff members, investigating their attitudes towards end-of-life practices. Statistical analysis included descriptive statistics and chi-square testing for the presence of associations (p<0.05 being significant) and Cramer's V for the strength of the association. Main outcome measured the correlation between the respondents' present code status and their preference for cardiopulmonary resuscitation in case of terminal illness.

RESULTS: 852 surveys were completed (99.3% response rate). Among the respondents 21% (n=180) were physicians, 36.9% (n=317) nurses, 10.5%(n=90) medical students, and 265 participants were other staff members of the institutions. Most respondents 58.3% (n=500) desired "Definitely full code" [physicians 73.2% (n=131)], only 13.8% of respondents [physicians 8.33% (n=15)] desired "Definitely no code" or "partial support", 20.9% respondents (n=179) [among physicians 18.4% (n=33)] had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness (p<0.001) but this association was overall quite weak (Cramer's V=0.180). Subgroup analysis revealed no association between current code status and terminal illness code preference among physicians (p=0.290) and nurses (p=0.316), whereupon other hospital workers were more consistent (p<0.01, Cramer's V=0.291).

CONCLUSIONS: Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo cardiopulmonary resuscitation may change when facing a terminal illness. From their perspective, cardiac arrest is less "terminal" than terminal illness.

CLINICAL IMPLICATIONS: Doctors and nurses provide medical advice to patients and families at the end-of-life. They are trained to view cardiac arrest as a reversible disease, even though the overwhelming majority of cases are terminal. Differences in perspective may affect counseling, and create friction between medical professionals and laypersons.

DISCLOSURE: The following authors have nothing to disclose: Luis Chavez, Karen Torres, Maria Duarte, Salim Surani, Sharon Einav, Joseph Varon

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