Checklist-guided Shared Decision-making for Code Status Discussions in Medical Inpatients.

Checklist-guided Shared Decision-making for Code Status Discussions in Medical Inpatients. A Cluster-randomized Multicenter Trial

This cluster-randomized, multicenter trial is designed to investigate the effect of checklist-guided shared decision-making including decision aids and communication of expected outcome on patients' decision regarding their code status, and at the same time, if it improves decision-making quality as judged by patient's decisional comfort, patient knowledge and involvement in decision-making and patient satisfaction. Patients in whom resuscitation is considered as futile will be treated separately in an ancillary project. In these patients a checklist to communicate the futility and the medical consequences will be used.

Inclusion Criteria:

1. physician level

   - residents on the medical wards will be the primary level of randomization.

2. patient level - any adult (>18 years) patient that is admitted for in-hospital care will be eligible.

Exclusion Criteria:

1. physician level

   - no exclusion criteria for physicians except if they refuse participation

2. patient level

   • patients unable to complete questionnaires or unable to follow code status discussions due to (1) intoxication, (2) paracusis; (3) serious psychiatric conditions (e.g., psychosis, depression with suicidal tendency, stupor), (4) cognitive impairment (e.g. dementia, delirium).
   • patients prior included in this study (i.e., patients who are hospitalized for the second time)