Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Deciding About Cardiopulmonary Resuscitation: The Contributions of Decision Analysis

Deciding About Cardiopulmonary Resuscitation: The Contributions of Decision Analysis Abstract Background: Patients have the right to decide whether to authorize cardiopulmonary resuscitation (CPR). Physicians should provide adequate information and help clarify preferences. Methods: The usefulness of decision analysis was investigated in two convenience samples: 20 healthy outpatient volunteers and 35 audience members at medical ethics grand rounds. Subjects quantified their relative preferences (utilities) for the outcomes of cardiac arrest. First, they rated them on a linear scale. Second, they participated in hypothetical gambles in which they indicated how much they would risk to avoid each outcome. The investigator then calculated the overall expected utilities of the CPR and no-CPR strategies. Results: Subjects were able to complete both the gambles and the rating scale. Utilities derived by the two methods differed greatly. Subjects had strong aversions to an outcome of severe long-term brain damage and widely varying ratings of an outcome of a short period of intensive care followed by death (intensive care unit death). Because intensive care unit death is far more likely than long-term brain damage, its utility was the prime determinant of whether CPR or no-CPR had the higher calculated expected utility. Conclusions: The methods of decision analysis showed promise as a means not only of informing patients about CPR but of helping them make rational choices. They also revealed the inadequacy of current data on the key outcome of intensive care unit death.(Arch Intern Med. 1995;155:513-521) References 1. Sorum PC. Limiting cardiopulmonary resuscitation. Albany Law Rev . 1994;57: 617-645. 2. Shmerling RH, Bedell S, Lilienfeld A, Delbanco TL. Discussing cardiopulmonary resuscitation: a study of elderly outpatients. J Gen Intern Med . 1988; 3:317-321.Crossref 3. Schonwetter RS, Teasdale TA, Taffet G, Robinson BE, Luchi RJ. Educating the elderly: cardiopulmonary resuscitation decisions before and after intervention. JAm Geriatr Soc . 1991;39:372-377. 4. Miller DL, Jahnigen DW, Gorbien MJ, Simbartl L. Cardiopulmonary resuscitation: how useful? attitudes and knowledge of an elderly population. Arch Intern Med . 1992;152:578-582.Crossref 5. Kellogg FR, Crain M, Corwin J, Brickner PW. Life-sustaining interventions in frail elderly persons: talking about choices. Arch Intern Med . 1992;152:2317-2320.Crossref 6. Schonwetter RS, Walker RM, Kramer DR, Robinson BE. Resuscitation decision making in the elderly: the value of outcome data. J Gen Intern Med . 1993; 8:295-300.Crossref 7. Murphy DJ, Burrows D, Santilli S, Kemp AW, Tenner S. The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med . 1994;330:545-549.Crossref 8. Gamble E, McDonald PJ, Lichstein PR. Knowledge, attitudes, and behavior of elderly persons regarding living wills. Arch Intern Med . 1991;151:277-280.Crossref 9. Paris BEC, Carrion VG, Meditch JS Jr, Capello CF, Mulvihill MN. Roadblocks to do-not-resuscitate orders: a study in policy implementation. Arch Intern Med . 1993;153:1689-1695.Crossref 10. Virmani J, Schneiderman LJ, Kaplan RM. Relationship of advance directives to physician-patient communication. Arch Intern Med . 1994;154:909-913.Crossref 11. Weinstein MC, Fineberg HV. Clinical Decision Analysis . Philadelphia, Pa: WB Saunders Co; 1980. 12. Sox HC Jr, Blatt MA, Higgins MC, Marton KI. Medical Decision Making . Stoneham, Mass: Butterworths; 1988. 13. Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Measuring preferences for health states worse than death. Med Decis Making . 1994;14:9-18.Crossref 14. DeBard ML. Cardiopulmonary resuscitation: analysis of 6-years' experience and review of the literature. Ann Emerg Med . 1981;10:408-416.Crossref 15. Bedell SE, Demanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;309:569-576.Crossref 16. McGrath RB. In-house cardiopulmonary resuscitation: after a quarter of a century. Ann Emerg Med . 1987;16:1365-1368.Crossref 17. Taffet GE, Teasdale TA, Luchi RJ. In-hospital cardiopulmonary resuscitation. JAMA . 1988;260:2069-2072.Crossref 18. George AL Jr, Folk BP III, Crecelius PL, Campbell WB. Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. Am J Med . 1989;87:28-34.Crossref 19. Moss AH. Informing the patient about cardiopulmonary resuscitation: when the risks outweigh the benefits. J Gen Intern Med . 1989;4:349-355.Crossref 20. Burns R, Graney MJ, Nichols LO. Prediction of in-hospital cardiopulmonary arrest outcome. Arch Intern Med . 1989;149:1318-1321.Crossref 21. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly. Ann Intern Med . 1989;111:199-205.Crossref 22. Marwick TH, Case CC, Siskind V, Woodhouse SP. Prediction of survival from resuscitation: a prognostic index derived from multivariate logistic model analysis. Resuscitation . 1991;22:129-137.Crossref 23. Blackhall L, Ziogas A, Azen SP. Low survival rate after cardiopulmonary resuscitation in a county hospital. Arch Intern Med . 1992;152:2045-2048.Crossref 24. Ebell MH. Prearrest predictors of survival following in-hospital cardiopulmonary resuscitation: a meta-analysis. J Fam Pract . 1992;34:551-558. 25. Jastremski MS. In-hospital cardiac arrest. Ann Emerg Med . 1993;22:113-117.Crossref 26. Beuret P, Feihl F, Vogt P, Perret A, Romand JA, Perret C. Cardiac arrest: prognostic factors and outcome at 1 year. Resuscitation . 1993;25:171-179.Crossref 27. Rosenberg M, Wang C, Hoffman-Wildes, Hickham D. Results of cardiopulmonary resuscitation: failure to predict survival in two community hospitals. Arch Intern Med . 1993;153:1370-1375.Crossref 28. Ebell MH. Artificial neural networks for predicting failure to survive following in-hospital cardiopulmonary resuscitation. J Fam Pract . 1993;36:297-303. 29. Bergner L, Hallstrom A, Bergner M, Eisenberg MS, Cobb LA. Health status of survivors of cardiac arrest and of myocardial infarction controls. Am J Public Health . 1985;75:1321-1323.Crossref 30. Roine RO, Kajaste S, Kaste M. Neuropsychological sequelae of cardiac arrest. JAMA . 1993;269:237-242.Crossref 31. Juchens R, Wahlig G, Frese W. Influence of age on the survival rate of out-of-hospital and in-hospital resuscitation. Resuscitation . 1993;20:23-29.Crossref 32. Sorum P. Evaluating whether a combined internal medicine-pediatrics practice was successful. Acad Med . 1991;66:353-358.Crossref 33. Cohen-Mansfield J, Rabinovich BA, Lipson S, et al. The decision to execute a durable power of attorney for health care and preferences regarding the utilization of life-sustaining treatments in nursing home residents. Arch Intern Med . 1991;151:289-294.Crossref 34. Redelmeier D, Rozin P, Kahneman D. Understanding patients' decisions: cognitive and emotional perspectives. JAMA . 1993;270:72-76.Crossref 35. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science . 1981;211:453-458.Crossref 36. McNeil BJ, Pauker SG, Sox HC Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med . 1982;306:1259-1262.Crossref 37. Hornberger JC, Redelmeier DA, Petersen J. Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis. J Clin Epidemiol . 1992;45:505-512.Crossref 38. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular defibrillation: prognosis and follow-up course. N Engl J Med . 1974;291:317-321.Crossref 39. Mattana J, Singhal PC. Prevalence and determinants of acute renal failure following cardiopulmonary resuscitation. Arch Intern Med . 1993;153:235-239.Crossref 40. Kasper JR, Mulley AG Jr, Wennberg JE. Developing shared decision-making programs to improve the quality of health care. Qual Rev Bull . 1992;18:163-190. 41. Gonzalez EF, Eckman MH, Pauker SG. 'Gambler': a computer workstation for patient utility assessment. Med Decis Making . 1992:12:350. Abstract. 42. Kneeland T, Nease R, Littenberg B, et al. Results of a computer-based utility assessment tool in 244 patients. Med Decis Making . 1993;13:391. Abstract. 43. Nord E. Methods for quality adjustment of life years. Soc Sci Med . 1992;34: 559-569.Crossref 44. Gillick MR. Talking with patients about risk. J Gen Intern Med . 1988;3:166-170.Crossref 45. Mazur DJ, Hickam DH. Patients' interpretations of probability terms. J Gen Intern Med . 1991;6:237-240.Crossref 46. Mazur DJ, Merz JF. How age, outcome severity, and scale influence general medicine clinic patients' interpretations of verbal probability terms. J Gen Intern Med . 1994;9:268-271.Crossref 47. Boyd NF, Sutherland HJ, Heasman KZ, Tritchler DL, Cummings BJ. Whose utilities for decision analysis? Med Decis Making . 1990;10:58-67.Crossref 48. Bass EB, Bergner M, Pitt HA, et al. Comparison of patient utilities for gallstone treatments and related outcomes by rating scale and standard gamble techniques. Med Decis Making . 1991;11:333. Abstract. 49. Downs SM, McNutt RA. Utility assessment of short term and permanent clinical outcomes. Med Decis Making . 1992;12:351. Abstract. 50. Percy ML, Llewellyn-Thomas HA. Assessing preferences about the DNR order: does it depend on how you ask? Med Decis Making . 1992:12:338. Abstract. 51. Froberg DG, Kane RL. Methods for measuring health-state preferences. J Clin Epidemiol . 1989;42:345-354, 459-471, 675-685.Crossref 52. Mulley AG Jr. Assessing patients' utilities: can the ends justify the means? Med Care . 1989;27( (suppl) ):S269-281.Crossref 53. Krumins PE, Fihn SD, Kent DL. Symptom severity and patients' values in the decision to perform a transurethral resection of the prostate. Med Decis Making . 1988;8:1-8.Crossref 54. Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ . 1986;5:1-30.Crossref 55. Llewellyn-Thomas HA, Sutherland HJ, Thiel EC. Do patients' evaluations of a future health state change when they actually enter that state? Med Care . 1993; 31:1002-1012.Crossref 56. Emanuel LL, Emanuel EJ, Stoeckle JD, Hummel LR, Barry MJ. Advance directives: stability of patients' treatment choices. Arch Intern Med . 1994;154:209-217.Crossref 57. Danis M, Garrett J, Harris R, Patrick DL. Stability of choices about life-sustaining treatments. Ann Intern Med . 1994;120:567-573.Crossref 58. O'Meara JJ, McNutt RA, Evans AT, Moore SW, Downs SM. A decision analysis of streptokinase plus heparin as compared with heparin alone for deepvein thrombosis. N Engl J Med . 1994;330:1864-1869.Crossref 59. Kassirer J. Incorporating patients' preferences into medical decisions. N Engl J Med . 1994;330:1895-1896.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Deciding About Cardiopulmonary Resuscitation: The Contributions of Decision Analysis

Archives of Internal Medicine , Volume 155 (5) – Mar 13, 1995

Loading next page...
 
/lp/american-medical-association/deciding-about-cardiopulmonary-resuscitation-the-contributions-of-XnYyfa5z8G

References (66)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430050091010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Patients have the right to decide whether to authorize cardiopulmonary resuscitation (CPR). Physicians should provide adequate information and help clarify preferences. Methods: The usefulness of decision analysis was investigated in two convenience samples: 20 healthy outpatient volunteers and 35 audience members at medical ethics grand rounds. Subjects quantified their relative preferences (utilities) for the outcomes of cardiac arrest. First, they rated them on a linear scale. Second, they participated in hypothetical gambles in which they indicated how much they would risk to avoid each outcome. The investigator then calculated the overall expected utilities of the CPR and no-CPR strategies. Results: Subjects were able to complete both the gambles and the rating scale. Utilities derived by the two methods differed greatly. Subjects had strong aversions to an outcome of severe long-term brain damage and widely varying ratings of an outcome of a short period of intensive care followed by death (intensive care unit death). Because intensive care unit death is far more likely than long-term brain damage, its utility was the prime determinant of whether CPR or no-CPR had the higher calculated expected utility. Conclusions: The methods of decision analysis showed promise as a means not only of informing patients about CPR but of helping them make rational choices. They also revealed the inadequacy of current data on the key outcome of intensive care unit death.(Arch Intern Med. 1995;155:513-521) References 1. Sorum PC. Limiting cardiopulmonary resuscitation. Albany Law Rev . 1994;57: 617-645. 2. Shmerling RH, Bedell S, Lilienfeld A, Delbanco TL. Discussing cardiopulmonary resuscitation: a study of elderly outpatients. J Gen Intern Med . 1988; 3:317-321.Crossref 3. Schonwetter RS, Teasdale TA, Taffet G, Robinson BE, Luchi RJ. Educating the elderly: cardiopulmonary resuscitation decisions before and after intervention. JAm Geriatr Soc . 1991;39:372-377. 4. Miller DL, Jahnigen DW, Gorbien MJ, Simbartl L. Cardiopulmonary resuscitation: how useful? attitudes and knowledge of an elderly population. Arch Intern Med . 1992;152:578-582.Crossref 5. Kellogg FR, Crain M, Corwin J, Brickner PW. Life-sustaining interventions in frail elderly persons: talking about choices. Arch Intern Med . 1992;152:2317-2320.Crossref 6. Schonwetter RS, Walker RM, Kramer DR, Robinson BE. Resuscitation decision making in the elderly: the value of outcome data. J Gen Intern Med . 1993; 8:295-300.Crossref 7. Murphy DJ, Burrows D, Santilli S, Kemp AW, Tenner S. The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med . 1994;330:545-549.Crossref 8. Gamble E, McDonald PJ, Lichstein PR. Knowledge, attitudes, and behavior of elderly persons regarding living wills. Arch Intern Med . 1991;151:277-280.Crossref 9. Paris BEC, Carrion VG, Meditch JS Jr, Capello CF, Mulvihill MN. Roadblocks to do-not-resuscitate orders: a study in policy implementation. Arch Intern Med . 1993;153:1689-1695.Crossref 10. Virmani J, Schneiderman LJ, Kaplan RM. Relationship of advance directives to physician-patient communication. Arch Intern Med . 1994;154:909-913.Crossref 11. Weinstein MC, Fineberg HV. Clinical Decision Analysis . Philadelphia, Pa: WB Saunders Co; 1980. 12. Sox HC Jr, Blatt MA, Higgins MC, Marton KI. Medical Decision Making . Stoneham, Mass: Butterworths; 1988. 13. Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Measuring preferences for health states worse than death. Med Decis Making . 1994;14:9-18.Crossref 14. DeBard ML. Cardiopulmonary resuscitation: analysis of 6-years' experience and review of the literature. Ann Emerg Med . 1981;10:408-416.Crossref 15. Bedell SE, Demanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;309:569-576.Crossref 16. McGrath RB. In-house cardiopulmonary resuscitation: after a quarter of a century. Ann Emerg Med . 1987;16:1365-1368.Crossref 17. Taffet GE, Teasdale TA, Luchi RJ. In-hospital cardiopulmonary resuscitation. JAMA . 1988;260:2069-2072.Crossref 18. George AL Jr, Folk BP III, Crecelius PL, Campbell WB. Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. Am J Med . 1989;87:28-34.Crossref 19. Moss AH. Informing the patient about cardiopulmonary resuscitation: when the risks outweigh the benefits. J Gen Intern Med . 1989;4:349-355.Crossref 20. Burns R, Graney MJ, Nichols LO. Prediction of in-hospital cardiopulmonary arrest outcome. Arch Intern Med . 1989;149:1318-1321.Crossref 21. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly. Ann Intern Med . 1989;111:199-205.Crossref 22. Marwick TH, Case CC, Siskind V, Woodhouse SP. Prediction of survival from resuscitation: a prognostic index derived from multivariate logistic model analysis. Resuscitation . 1991;22:129-137.Crossref 23. Blackhall L, Ziogas A, Azen SP. Low survival rate after cardiopulmonary resuscitation in a county hospital. Arch Intern Med . 1992;152:2045-2048.Crossref 24. Ebell MH. Prearrest predictors of survival following in-hospital cardiopulmonary resuscitation: a meta-analysis. J Fam Pract . 1992;34:551-558. 25. Jastremski MS. In-hospital cardiac arrest. Ann Emerg Med . 1993;22:113-117.Crossref 26. Beuret P, Feihl F, Vogt P, Perret A, Romand JA, Perret C. Cardiac arrest: prognostic factors and outcome at 1 year. Resuscitation . 1993;25:171-179.Crossref 27. Rosenberg M, Wang C, Hoffman-Wildes, Hickham D. Results of cardiopulmonary resuscitation: failure to predict survival in two community hospitals. Arch Intern Med . 1993;153:1370-1375.Crossref 28. Ebell MH. Artificial neural networks for predicting failure to survive following in-hospital cardiopulmonary resuscitation. J Fam Pract . 1993;36:297-303. 29. Bergner L, Hallstrom A, Bergner M, Eisenberg MS, Cobb LA. Health status of survivors of cardiac arrest and of myocardial infarction controls. Am J Public Health . 1985;75:1321-1323.Crossref 30. Roine RO, Kajaste S, Kaste M. Neuropsychological sequelae of cardiac arrest. JAMA . 1993;269:237-242.Crossref 31. Juchens R, Wahlig G, Frese W. Influence of age on the survival rate of out-of-hospital and in-hospital resuscitation. Resuscitation . 1993;20:23-29.Crossref 32. Sorum P. Evaluating whether a combined internal medicine-pediatrics practice was successful. Acad Med . 1991;66:353-358.Crossref 33. Cohen-Mansfield J, Rabinovich BA, Lipson S, et al. The decision to execute a durable power of attorney for health care and preferences regarding the utilization of life-sustaining treatments in nursing home residents. Arch Intern Med . 1991;151:289-294.Crossref 34. Redelmeier D, Rozin P, Kahneman D. Understanding patients' decisions: cognitive and emotional perspectives. JAMA . 1993;270:72-76.Crossref 35. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science . 1981;211:453-458.Crossref 36. McNeil BJ, Pauker SG, Sox HC Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med . 1982;306:1259-1262.Crossref 37. Hornberger JC, Redelmeier DA, Petersen J. Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis. J Clin Epidemiol . 1992;45:505-512.Crossref 38. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular defibrillation: prognosis and follow-up course. N Engl J Med . 1974;291:317-321.Crossref 39. Mattana J, Singhal PC. Prevalence and determinants of acute renal failure following cardiopulmonary resuscitation. Arch Intern Med . 1993;153:235-239.Crossref 40. Kasper JR, Mulley AG Jr, Wennberg JE. Developing shared decision-making programs to improve the quality of health care. Qual Rev Bull . 1992;18:163-190. 41. Gonzalez EF, Eckman MH, Pauker SG. 'Gambler': a computer workstation for patient utility assessment. Med Decis Making . 1992:12:350. Abstract. 42. Kneeland T, Nease R, Littenberg B, et al. Results of a computer-based utility assessment tool in 244 patients. Med Decis Making . 1993;13:391. Abstract. 43. Nord E. Methods for quality adjustment of life years. Soc Sci Med . 1992;34: 559-569.Crossref 44. Gillick MR. Talking with patients about risk. J Gen Intern Med . 1988;3:166-170.Crossref 45. Mazur DJ, Hickam DH. Patients' interpretations of probability terms. J Gen Intern Med . 1991;6:237-240.Crossref 46. Mazur DJ, Merz JF. How age, outcome severity, and scale influence general medicine clinic patients' interpretations of verbal probability terms. J Gen Intern Med . 1994;9:268-271.Crossref 47. Boyd NF, Sutherland HJ, Heasman KZ, Tritchler DL, Cummings BJ. Whose utilities for decision analysis? Med Decis Making . 1990;10:58-67.Crossref 48. Bass EB, Bergner M, Pitt HA, et al. Comparison of patient utilities for gallstone treatments and related outcomes by rating scale and standard gamble techniques. Med Decis Making . 1991;11:333. Abstract. 49. Downs SM, McNutt RA. Utility assessment of short term and permanent clinical outcomes. Med Decis Making . 1992;12:351. Abstract. 50. Percy ML, Llewellyn-Thomas HA. Assessing preferences about the DNR order: does it depend on how you ask? Med Decis Making . 1992:12:338. Abstract. 51. Froberg DG, Kane RL. Methods for measuring health-state preferences. J Clin Epidemiol . 1989;42:345-354, 459-471, 675-685.Crossref 52. Mulley AG Jr. Assessing patients' utilities: can the ends justify the means? Med Care . 1989;27( (suppl) ):S269-281.Crossref 53. Krumins PE, Fihn SD, Kent DL. Symptom severity and patients' values in the decision to perform a transurethral resection of the prostate. Med Decis Making . 1988;8:1-8.Crossref 54. Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ . 1986;5:1-30.Crossref 55. Llewellyn-Thomas HA, Sutherland HJ, Thiel EC. Do patients' evaluations of a future health state change when they actually enter that state? Med Care . 1993; 31:1002-1012.Crossref 56. Emanuel LL, Emanuel EJ, Stoeckle JD, Hummel LR, Barry MJ. Advance directives: stability of patients' treatment choices. Arch Intern Med . 1994;154:209-217.Crossref 57. Danis M, Garrett J, Harris R, Patrick DL. Stability of choices about life-sustaining treatments. Ann Intern Med . 1994;120:567-573.Crossref 58. O'Meara JJ, McNutt RA, Evans AT, Moore SW, Downs SM. A decision analysis of streptokinase plus heparin as compared with heparin alone for deepvein thrombosis. N Engl J Med . 1994;330:1864-1869.Crossref 59. Kassirer J. Incorporating patients' preferences into medical decisions. N Engl J Med . 1994;330:1895-1896.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 13, 1995

There are no references for this article.