Does Checklist-Guided Shared Decision Making Have a Sustained Effect on Code Status Decisions Among Medical Inpatients? Long-Term Follow Up of the Randomized CLEAR Checklist Trial.
Benjamin Bissmann, Samuel K Zumbrunn, Sebastian Gross et al.
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In 30 seconds
This long-term follow-up of a prospective randomized controlled trial assessed whether checklist-guided shared decision-making for code status had sustained effects among medical inpatients. Of 1,954 participants in the original CLEAR trial, 1,340 were included in the follow-up analysis, conducted after a mean of 3.2 years. The intervention group had a higher rate of documented do-not-resuscitate status than the usual-care group (36.1% vs. 29.8%; adjusted risk ratio 1.23, 95% CI 1.04 to 1.45, p = 0.02). Knowledge about resuscitation measures did not differ significantly.
Key findings
- Documented DNR status was more frequent after checklist-guided discussions than usual care: 36.1% vs. 29.8% (adjusted risk ratio 1.23, 95% CI 1.04 to 1.45, p = 0.02).
- At a mean follow-up of 3.2 years, the groups did not differ significantly in knowledge about resuscitation measures.
Why it matters
The findings suggest that a structured code status discussion may have a lasting association with documented preferences, even when specific knowledge about resuscitation and its outcomes is not retained. This distinction matters because documentation of a preference does not itself establish that the decision remains informed or consistent with a patient's current values.
What to keep in mind
The follow-up analysis included 1,340 of the original 1,954 inpatients; 604 had died and 10 were excluded for missing information. The reported outcomes were assessed years after the initial discussion.