Choice of Diction's Effect

Study Overview
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Brief Summary
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The purpose of the research is to determine how the language used when discussing preferences about cardiopulmonary resuscitation (CPR) affects decisions regarding this (code status)

Detailed Description
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Most Americans express a preference for dying at home naturally and surrounded by loved ones. However, many also believe that cardiopulmonary resuscitation (CPR) is more effective than it is, and want to have CPR even when the chances for a good outcome is poor. Among other reasons, the alternative term (Do Not Resuscitate, or DNR) has been shown in the literature to be associated by patients with passive, sub-optimal, and low quality care. This study will attempt to determine patient preference for the no CPR term on patients admitted to the hospital using alternate phrasing. During admission to the Medical Teaching Service, patients over the age of 65 who are able to consent and who are not critically ill/unstable will be approached. After checking brief background questions (such as if they ever had discussions like these before), they will be randomized into two groups and asked code status using one of the two phrases. This question will determine the patient's code status; asking for this is a routine part of hospitalized care that is required by law (the exact terminology is left to the care team). After determining the patient's code status, they will be asked how satisfied they were with the decision; the investigator will be asked if they agree with the decision separately. Demographic and clinical information will be collected. Six months later, the patient will be contacted again; at this time, they will be asked about recent life and health changes. Finally, they will be asked their code status one more time. This will conclude the participant's involvement in the study

Official Title
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Choice Of Diction's Effect: Effects in No Code Phrasing on Code Status Discussions

Conditions
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Communication, Advance Directives, Decision Making, Cardiopulmonary Resuscitation

Intervention / Treatment
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* Other: Alternative phrasing for no code
* Other: Standard of care for no code


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 65 or older English-fluency in reading and speaking Capacity to consent Exclusion Criteria: Unstable psychiatric illness Unstable/critically ill patients requiring ICU-level care Active substance abuse

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Alternative Phrase<br>This arm will have the code status question randomized to offer CPR vs the alternative phrase | Other: Alternative phrasing for no code<br>* This intervention will use the alternative phrase noted in the literature when discussing code status. This will be the only intervention, and all other aspects of trial participation will be collection of data<br>|
| Active Comparator: Standard of care phrase<br>This arm will have the code status question randomized to offer CPR vs the standard of care phrase | Other: Standard of care for no code<br>* This intervention will use the standard of care phrase noted in the literature when discussing code status. This will be the only intervention, and all other aspects of trial participation will be collection of data<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Code Status Selection | Selection of code versus no code decision depending on phrasing used, stratified by GO-FAR calculation | Immediately collected after consent and randomization into a study arm | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant Satisfaction with Decision | Determine patient satisfaction of, and provider agreement with, code discussion. The former will be measured using a modified Satisfaction with Decision Scale, a six-item Likert scale indicating agreement or not with the statements provided. The latter will be determined by asking the physician if they agree (yes/no/unsure) | Immediately collected after consent and randomization into a study arm | 
| Length of Conversation | Determine whether there is a difference of conversation length between phrasing groups (measured in minutes) | Immediately collected after consent and randomization into a study arm | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Older Adult, Allow a Natural Death, Do Not Resuscitate, Resuscitation Decisions