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Deferred Decision Making: patients’ reliance on family and physicians for cpr decisions in critical care

University of North Carolina at Chapel Hill, NC, USA, shkim{at}email.unc.edu

Diane Kjervik

University of North Carolina at Chapel Hill, NC, USA

The aim of this study was to investigate factors associated with seriously ill patients’ preferences for their family and physicians making resuscitation decisions on their behalf. Using SUPPORT II data, the study revealed that, among 362 seriously ill patients who were experiencing pain, 277 (77%) answered that they would want their family and physicians to make resuscitation decisions for them instead of their own wishes being followed if they were to lose decision-making capacity. Even after controlling for other variables, patients who preferred the option of undergoing cardiopulmonary resuscitation (CPR) in the future were twice as likely, and those who had had ventilator treatment were four-fifths less likely, to rely on their family and physicians than those who did not want CPR (odds ratio (OR)-2.28; 95% confidence interval (CI) 1.18-4.38) or those who had not received ventilator treatment (OR-0.23; 95% CI 0.06-0.90). Psychological variables (anxiety, quality of life, and depression), symptomatic variables (severity of pain and activities of daily living) and the existence of surrogates were not significantly associated with patients’ preferences for having their family and physicians make resuscitation decisions for them. Age was not a significant factor for predicting the decision-making role after controlling for other variables.

Key Words: autonomy • cardiopulmonary resuscitation decision making • experience of health care treatments • seriously ill patients

Nursing Ethics, Vol. 12, No. 5, 493-506 (2005)
DOI: 10.1191/0969733005ne817oa


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