Background Medical residents frequently discuss code status and other end-of-life (EOL) issues with patients. Resident beliefs regarding the outcome of codes and patient understanding of do not resuscitate (DNR) orders may influence these conversations.
Methods During September 2005 an anonymous survey was administered to all internal medicine residents. The survey was composed of 15 items including demographics, open-ended responses, and Likert scale measures of skill and comfort with EOL issues. Five items were repeated from and compared to a 1995 resident survey that assessed perception of outcomes and experiences with patients who are DNR.
Results Fifty-five residents completed the survey (response rate 64%). More than two-thirds of residents reported participating in more than 20 discussions of code status. The median number of codes attended was 10. The mean perceived survival rate was 21%, which was comparable to the 1995 data. The residents reported regretting resuscitating 23% of patients compared to 44% in 1995 (p < .001). They estimated that only 34% of patients or families understand resuscitation compared to 53% a decade ago (p < .001).
Conclusions Residents perceive codes as more appropriate compared to a decade ago, while the number of codes attended and perceived survival rate were similar across time. Though current residents are less likely to regret resuscitation, they believe far fewer patients understand it. These findings raise important questions about how preconceived notions, doctor-patient communication, and health literacy impact EOL care.
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