What should we say when discussing "code status" and life support with a patient? A Delphi analysis.

Abstract

Patients and clinicians often find it difficult to discuss wishes regarding cardiopulmonary resuscitation (CPR) or "code status." Some authors have published effective communication styles, but there are currently no published guidelines for the content of a discussion about resuscitation or goals of care. We identified a group of physicians with expertise in end-of-life care and communication, and used the Delphi method to develop a series of consensus statements about the ideal content of a discussion of CPR and goals of care. Twelve physicians agreed to participate in the study, generating nine consensus statements. These statements addressed the following topics: timing the discussion; framing the discussion in terms of "goals of care"; distinguishing between life-sustaining therapy (LST) and CPR; describing a cardiac arrest, LST, CPR, and palliative care; describing what happens after a cardiac arrest; how to modify the discussion to respect a patient's medical condition or beliefs; offering a prognosis; making a recommendation; and the importance of trust and rapport. There was consensus for each statement after the second Delphi round. Physicians with expertise in end-of-life care and communication were able to develop consensus statements for the ideal content of a discussion of CPR and goals of care. These statements can serve as guidelines for physicians who feel uncomfortable with these discussions, in order to facilitate effective, informed, and ethically sound decision making.