Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis
Authors: Gwen M. Bernacki, Ruth A. Engelberg, J. Randall Curtis, Manjula Kurella Tamura, Lyndia C. Brumback, Danielle C. Lavallee, Elizabeth K. Vig, Ann M. O’Hare
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Whether the cardiopulmonary resuscitation (CPR) preferences of patients receiving dialysis align with their values and other aspects of end-of-life care is not known. <h3>Objective</h3> To describe the CPR preferences of patients receiving dialysis and how these preferences are associated with their responses to questions about other aspects of end-of-life care. <h3>Design, Setting, and Participants</h3> Cross-sectional survey study of a consecutive sample of patients receiving dialysis at 31 nonprofit dialysis facilities in 2 US metropolitan areas (Seattle, Washington, and Nashville, Tennessee) between April 22, 2015, and October 2, 2018. Analyses for this article were conducted between December 2018 and April 2020. <h3>Exposures</h3> Participants were asked to respond to the question "If you had to decide right now, would you want CPR if your heart were to stop beating?" Those who indicated they would probably or definitely want CPR were categorized as preferring CPR. <h3>Main Outcomes and Measures</h3> This study examined the association between preference for CPR and other treatment preferences, engagement in advance care planning, values, desired place of death, expectations about prognosis, symptoms, and palliative care needs. <h3>Results</h3> Of the 1431 individuals invited to complete the survey, 1006 agreed to participate, and 873 were included in the analytic cohort (61.0%). The final cohort had a mean (SD) age of 62.6 (14.0) years; 489 (56.0%) were men, and 526 (60.3%) were White individuals. Among 736 of 873 participants (84.3%) who indicated that they would definitely or probably want CPR (CPR group), 554 (75.3%) wanted mechanical ventilation vs 13 of 137 (9.5%) of those who did not want CPR (do not resuscitate [DNR] group) (<i>P</i> &lt; .001). A total of 248 of 736 participants (33.7%) in the CPR group vs 83 of 137 (60.6%) in the DNR group had documented treatment preferences (<i>P</i> &lt; .001). In terms of values about future care, 171 participants (23.2%) in the CPR group vs 5 of 137 (3.7%) in the DNR group valued life prolongation (<i>P</i> &lt; .001); 319 in the CPR group (43.3%) vs 108 of 137 in the DNR group (78.8%) valued comfort (<i>P</i> &lt; .001); and 246 participants (33.4%) in the CPR group vs 24 of 137 (17.5%) in the DNR group were unsure about their wishes for future care (<i>P</i> &lt; .001). In the CPR group, 207 (28.1%) had thought about stopping dialysis vs 62 of 137 (45.3%) in the DNR group (<i>P</i> &lt; .001), and 181 (24.6%) vs 57 of 137 (41.6%) had discussed stopping dialysis (<i>P</i> = .001). No statistically significant associations were observed between CPR preference and documentation of a surrogate decision maker, thoughts or discussion of hospice, preferred place of death, expectations about prognosis, reported symptoms, or palliative care needs. <h3>Conclusions and Relevance</h3> The CPR preferences of patients receiving dialysis were associated with some, but not all, other aspects of end-of-life care. How participants responded to questions about these other aspects of end-of-life care were not always aligned with their CPR preference. More work is needed to integrate discussions about code status with bigger picture conversations about patients' values, goals, and preferences for end-of-life care.