Doctor's choice of words may influence family's decision to permit CPR in critically ill

A physician's choice of words when talking with family members about whether or not to try cardiopulmonary resuscitation (CPR) if a critically ill patient's heart stops may influence the decision, according to a study by University of Pittsburgh researchers in the June edition of Critical Care Medicine and now available online.

"It's long been known that the way a choice is framed can influence people's decisions," noted Amber E. Barnato, M.D., M.P.H., M.S., lead author of the study and associate professor of clinical and translational science at the University of Pittsburgh School of Medicine. "Our study shows that the words physicians use may play an important role in determining critical end-of-life decisions."

For this first-of-its-kind study, Dr. Barnato and her team recruited more than 250 or spouses in eight cities: Boston, Atlanta, New York, Los Angeles, San Francisco, Dallas, Denver and Pittsburgh.

The participants took part in a Web-based survey involving a hypothetical situation in which a loved one was in the with a 40 percent chance of dying from , a dangerous . Some subjects were shown a photo of their loved ones to help them imagine the situation and heighten the . An actor portrayed a physician who held a virtual, interactive meeting with the family member. The "doctor's" responses varied, using different words for the same scenarios. Additionally, some offered , and others offered only clinical information.

A key finding was that when participants were asked to choose between having their loved ones receive CPR if their hearts should stop—a treatment with a 10 percent chance of successfully reviving them—or the alternative, a "Do Not Resuscitate" (DNR) order, 60 percent chose CPR. When the alternative was described as to "allow natural death" instead of a DNR order, the number choosing CPR dropped to 49 percent.

When the actor cited "his own experience" about how most others handled such a situation, family members were more likely to choose what they believed was the common approach.

Using more empathic language did not influence CPR choice.

"Simple changes of words and perceptions about social norms resulted in large differences in CPR choices," said Dr. Barnato. "The change in terminology from 'DNR' to 'allow natural death' already has been implemented in a health system in Texas. This study suggests that the change isn't just window dressing—it makes a real difference in the choices that people make. We expect that it also may reduce feelings of guilt for choosing against by making family members feel like they are doing something positive to honor their loved one's wishes at the end of life, rather than taking something away from them."

Related Stories

Recommended for you

ER doctors stress need for good communications with police

date 10 hours ago

A good working relationship with police is essential for the smooth operation of a busy Emergency Department. Police are in and out of EDs regularly, supporting EMS, transporting patients and helping to provide a safe environment ...

AMA: avoiding distress in medical school

date May 22, 2015

(HealthDay)—Understanding the key drivers underlying medical students' distress can help address the issues and enhance student well-being, according to an article published by the American Medical Association.

European court to rule on right-to-die case

date May 21, 2015

Europe's human rights court will on June 5 rule on whether a man in a vegetative state can be taken off life support, a case that has ignited a fierce euthanasia debate in France, a spokesman said Thursday.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.