Intuition vs. Deliberation in Medical Decision Making

Intuition Versus Deliberation in Decisions About Life-Sustaining Medical Therapies

The purpose of this study is to determine whether there are systematic differences between the decisions patients make intuitively versus deliberatively about life-sustaining medical therapies.

The targeted population is inpatients at the Hospital of the University of Pennsylvania with serious medical problems. The study will involve facilitated interviews with patients using a survey instrument developed in Qualtrics.

Inclusion Criteria:

1. Age 60 and older

2. Currently an inpatient at Hospital of the University of Pennsylvania

3. Speaks and reads fluently in English

4. Either

   1. Has one of the following medical conditions:

      • Chronic obstructive pulmonary disease with at least severe airflow obstruction on most recent spirometry and/or eligible for long-term oxygen therapy
      • Incurable interstitial lung disease with at least severe restriction on most recent pulmonary function tests and/or eligible for long-term oxygen therapy
      • Congestive heart failure with NYHA Class III or higher and current hospitalization related to heart failure
      • Acute myeloid leukemia
      • Stage IV lymphoma
      • Stage IIIB or Stage IV non-small cell lung cancer, cholangiocarcinoma, renal cell carcinoma, breast cancer, uterine cancer, cervical cancer, ovarian cancer, colorectal cancer, gastric cancer, pancreatic cancer, prostate cancer, urothelial cancer
      • Stage C or D hepatocellular carcinoma
      • Mesothelioma or any malignancy metastatic to the pleura; or

   2. Is hospitalized on oncology, pulmonary or cardiology service and has been hospitalized at least one other time during the last year on the same service

5. Stable vital signs

Exclusion Criteria:

1. Notation of code status limitation in electronic medical record
2. Cognitive impairment to the point unable to give informed consent
3. Current feeding tube placement
4. Current tracheostomy
5. Severe pain, shortness of breath or other uncontrolled symptoms
6. Actively undergoing evaluation for solid organ transplant
7. First hospitalization after diagnosis of serious illness