Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members

Chest. 2006 Aug;130(2):419-28. doi: 10.1378/chest.130.2.419.


Background: To improve communication and decision making related to cardiopulmonary resuscitation (CPR), a greater understanding of the perspectives of hospitalized patients with advanced diseases and their family members are needed.

Methods: In five Canadian hospitals, we administered a face-to-face questionnaire to older inpatients with end-stage cancer and advanced medical diseases and, where possible, to one of their family members, regarding information needs, the deliberation process, and their preferred decisional role.

Findings: A total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%) agreed to participate. Most patients (61%) had thought about what treatment they wanted if their heart stopped, few patients (11.3%) could describe more than two components of CPR, and only 2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients (34%) had discussed CPR with their physician; 37% did not want to discuss their preferences with their doctor. Patients who felt that end-of-life issues were relevant to them were 5.5 times more likely to want a discussion with the physician regarding resuscitation (odds ratio, 5.5; 95% confidence interval, 2.5 to 12.0). The preferred role in decision making was variable, but most patients (59.7%) and family members (81.6%) preferred some degree of shared decision making that included the family member. There were no significant differences between cancer and medical patients in their preferred decisional role.

Interpretation: Seriously ill hospitalized patients have poor knowledge about CPR, and variable preferences for deliberation and their role in the decision-making process regarding their treatment. Strategies that improve understanding of CPR and foster discussions that involve patients, family members, and physicians in the decision-making process may improve the quantity and quality of communication and decision making about CPR.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Canada
  • Cardiopulmonary Resuscitation / psychology*
  • Critical Illness / psychology
  • Critical Illness / therapy*
  • Decision Making*
  • Female
  • Follow-Up Studies
  • Humans
  • Inpatients*
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Patient Participation
  • Physician-Patient Relations
  • Resuscitation Orders
  • Surveys and Questionnaires
  • Terminal Care / methods*