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Code status discussions in medical inpatients: results of a survey of patients and physicians
Open accessAbstract
INTRODUCTION Code status discussions are useful for understanding patients’ preferences in the case of a cardiac/pulmonary arrest. These discussions can also provide patients with a basis for informed decision-making regarding life-sustaining treatment. We conducted a survey to understand current practices and perceptions of code status discussions in a tertiary-care Swiss hospital. METHODS We performed systematic interviews across different departments of the University Hospital of Basel. We interviewed 258 physicians and 145 patients who were hospitalised between May and July 2018 using a questionnaire designed to assess the use of code status discussions and to gauge patients’ individual experiences and opinions. RESULTS A total of 61.4% of patients did not recall having had a code status discussion during the hospital stay. However, a higher proportion of medical patients compared to surgical patients recalled having had a discussion (43.6 vs 22.4%, p = 0.03). For 9 out of 38 (23.7%) patients who did recall the discussion, there was a lack of agreement between the preference given in the interview regarding resuscitation measures and the documented code status in the medical electronic chart. Furthermore, a majority of physicians (72.4%) recalled defining a do-not-resuscitate (DNR) status for a patient without prior discussion with the patient. Physicians who recalled determining the DNR status without patient consultation reported conflicts with patients and relatives regarding code status at a higher rate compared to physicians who did not define DNR status without consultation (62.4 vs 39.4%, p <0.001). CONCLUSION A majority of patients do not report having discussed code status during their hospital stay and physicians frequently omit such discussions, thereby potentially failing to attend to patients’ preferences for care. Physician training regarding code status discussions may improve the quality of informed decision-making and patient-centred care.
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For 40% of patients with an advance directive, their preference did not match the documented code status.
“For 40% of patients with an advance directive, their preference did not match the documented code status.29”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [29]
The Results report a mismatch between stated resuscitation preferences and documented code status, but it occurred in 9 of 38 patients (23.7%) who recalled a code-status discussion. Our copy does not report a 40% mismatch among patients with an advance directive. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWhen physicians were determining the DNACPR status for a patient, conflicts were reported at a higher rate (62.4%).
“When physicians were determining the DNACPR status for a patient, conflicts were reported at a higher rate (62.4%).29”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [29]
The Results report a 62.4% conflict rate, compared with 39.4%, specifically among physicians who recalled determining DNR status without consulting the patient. The claim omits that condition, making the higher rate sound applicable to physicians determining DNR status generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAbe et al, Becker et al and Choi et al identified DNACPR decisions within the hospitalisation period.
“More broadly, Abe et al,28 Becker et al29 and Choi et al30 identify DNACPR decisions within the hospitalisation period”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [29]
There was a 23.7% disagreement between preference given and documented code status in the medical electronic chart.
“There was a 23.7% disagreement between preference given and documented code status in the medical electronic chart.29”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [29]
76.2% of physicians rated the influence of religion on code status decisions and 82.9% of physicians rated the influence of culture.
“76.2% of physicians rated the influence of religion on code status decisions and 82.9% of physicians rated the influence of culture.29”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [29]
The Results section reports percentages concerning code status discussions and DNR decisions, but not physicians’ ratings of religion or culture. Searches for 76.2%, 82.9%, religion, and culture found no passage in our copy supporting the two figures. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Bedulli, M., Falvo, I., Merlani, P., Hurst, S., & Fadda, M. (2023) · PLOS ONE · doi:10.1371/journal.pone.0282270 · Cited by 12
Code status documentation at admission in COVID-19 patients: a descriptive cohort study
Briedé, S., van Goor, H. M. R., de Hond, T. A. P., van Roeden, S. E., Staats, J. M., Oosterheert, J. J., van den Bos, F., & Kaasjager, K. A. H. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-050268 · Cited by 10
Do not attempt cardiopulmonary resuscitation decision-making process: scoping review
Doody, O., Davidson, H., & Lombard, J. (2025) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2023-004573 · Cited by 10
“29 El-Jawahri et al 59 recommended a video decision support tool.”
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Metadata
- Authors
- Becker, C., Kuenzli, N., Perrig, S., Beck, K., Vincent, A., Widmer, M., Thommen, E., Schaefert, R., Bassetti, S., & Hunziker, S.
- Affiliations
- University Hospital of Basel (CH)
- University of Basel (CH)
- ORCID
- Venue
- Swiss Medical Weekly
- Publisher
- SMW Supporting Association
- Published
- 2020-03-23
- Volume
- 150
- Issue
- 1314
- Pages
- w20194
- ISSN
- 0036-7672 (ISSN-L)
- 1424-3997
- OpenAlex
- W3015185359
- Cited by
- 26
- References
- 0
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 8 · 2023: 6 · 2022: 3 · 2021: 2
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Swiss Medical Weekly (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- code status discussions, do-not-resuscitate orders, advance directives, end-of-life decisions, patient preferences, physician-patient communication, medical inpatients, patient-centered care, physician training, family conflict, cardiac arrest
- MeSH terms
- Decision Making, Humans, Inpatients, Physician-Patient Relations, Physicians, Surveys and Questionnaires, Resuscitation Orders
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