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Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis

Becker, Christoph and Lecheler, Leopold and Hochstrasser, Seraina and Metzger, Kerstin A. and Widmer, Madlaina and Thommen, Emanuel B. and Nienhaus, Katharina and Ewald, Hannah and Meier, Christoph A. and Rueter, Florian and Schaefert, Rainer and Bassetti, Stefano and Hunziker, Sabina. (2019) Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis. JAMA network open, 2 (6, e195033). pp. 1-17.

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Official URL: https://edoc.unibas.ch/71494/

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Abstract

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.
Faculties and Departments:03 Faculty of Medicine > Departement Klinische Forschung > Clinical Epidemiology and Biostatistics CEB
10 Zentrale universitäre Einrichtungen > Universitätsbibliothek
UniBasel Contributors:Ewald, Hannah
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:American Medical Association
ISSN:2574-3805
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:16 Sep 2019 13:18
Deposited On:16 Sep 2019 13:18

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