Written by Peter Liu
Spoon Feed
In code status discussions, a patient-values-centered framework was superior to an information-centered framework in making patients feel heard and understood.
Code status conversations are compassionate communication – prioritize emotional impact over technical content
Code status discussions are frequently relevant in the care of our severely sick patients, and the solemn nature of these discussions frequently leaves a large impact on the doctor-patient relationship, offering gateways into deeper discussions about other important care topics, such as goals of care and limitations in treatment. The featured study today offers a helpful dichotomy between an “information-centered” versus “patient-values-centered” approach to these discussions, and offers an example script for questions that are helpful in eliciting relevant patient values. In this single-center RCT of 46 patients recently discharged from an academic hospital, more patients reported feeling completely heard and understood with a patient-values-centered approach (63% vs 32%). Interestingly, more patients elected to be full code with a patient-values-centered approach as well (86.4% vs 54.5%, p=0.02). The trial highlights that patients can be quite heterogeneous in their preferences, and sticking to a script without ample room for personalization is unlikely to be the best strategy for all patients. Additionally, this study had little representation of non-white patients, so generalizability to other populations may be an issue. I did, however, find the frameworks utilized in this study to be very informative for me as a general practitioner who is frequently engaged in the palliative care of my patients.
How will this change my practice?
I will definitely be performing patient-value-centered code discussions more frequently in my own practice, and utilizing several of the patient-centered questions used in this study.
Source
Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered Frameworks. J Gen Intern Med. 2024 Dec 11. doi: 10.1007/s11606-024-09243-2. Epub ahead of print. PMID: 39663339
