Resuscitation: How Do We Decide?
Charleson, Mary E.
Sax, Frederic L.
Fields, Suzanne D.
Braham, Robert L.
JAMA. 1986 Mar 14; 255(10): 1316-1322.
A study was undertaken to identify the determinants of physicians' decisions about the treatment status of all patients admitted to the medical service of the New York Hospital-Cornell Medical Center during a one-month period. It was found that the patient's age, prognosis, and functional status were the main factors considered in assigning "full" vs. "not-full" intervention. Within prognostically similar groups, there was no significant difference in mortality rates between "full" and "not-full" intervention patients. Except for admission to intensive care units the level of care was not lower for "not-full" intervention patients. The investigators conclude that, because most severely ill patients survive and patient participation in resuscitation decisions is psychologically stressful, the optimal strategy is to limit initiation of such discussions to those patients whose hospital course is marked by a steady deterioration. (KIE abstract)
Aged; Chronically Ill; Critically Ill; Decision Making; Diagnosis; Hospitals; Institutional Policies; Intensive Care Units; Investigators; Life; Morbidity; Mortality; Patient Participation; Patients; Physicians; Prognosis; Psychological Stress; Quality of Life; Resuscitation; Resuscitation Orders; Residency; Selection for Treatment; Statistics; Survey; Terminally Ill;
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