Evidence map›Paper›PMID 33452662›Full record

ArticleCanadian journal of anaesthesia = Journal canadien d'anesthesie2021

Exploring and reconciling discordance between documented and preferred resuscitation preferences for hospitalized patients: a quality improvement study.

Ravi Taneja, Robert Sibbald, Launa Elliott, Elizabeth Burke, Kristen A Bishop, Philip M Jones, Mark Goldszmidt

Abstract read
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In one paragraph

Article in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Resuscitation preference conversation typologies: a constructivist grounded theory study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026
    Article
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Ravi TanejaDivision of Critical Care, University of Western Ontario, London, ON, Canada. Ravi.taneja@lhsc.on.ca.ORCID http://orcid.org/0000-0002-5361-9208
Robert SibbaldCentre for Education Research and Innovation, University of Western Ontario, London, ON, Canada.
Launa ElliottDivision of Critical Care, University of Western Ontario, London, ON, Canada.
Elizabeth BurkeDivision of Critical Care, University of Western Ontario, London, ON, Canada.
Kristen A BishopCentre for Education Research and Innovation, University of Western Ontario, London, ON, Canada.
Philip M JonesDepartment of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada.
Mark GoldszmidtDepartment of Medicine, Division of Internal Medicine, University of Western Ontario, London, ON, Canada.

Funding

Academic Medical Organization of Southwestern Ontario INN17-003Academic Medical Organization of Southwestern Ontario S15-001
6 · The paper itself

Abstract

purposeA discordance, predominantly towards overtreatment, exists between patients' expressed preferences for life-sustaining interventions and those documented at hospital admission. This quality improvement study sought to assess this discordance at our institution. Secondary objectives were to explore if internal medicine (IM) teams could identify patients who might benefit from further conversations and if the discordance can be reconciled in real-time.

methodsTwo registered nurses were incorporated into IM teams at a tertiary hospital to conduct resuscitation preference conversations with inpatients either specifically referred to them (group I, n = 165) or randomly selected (group II, n = 164) from 1 August 2016 to 31 August 2018. Resuscitation preferences were documented and communicated to teams prompting revised resuscitation orders where appropriate. Multivariable logistic regression was used to determine potential risk factors for discordance.

resultsThree hundred and twenty-nine patients were evaluated with a mean (standard deviation) age of 80 (12) and Charlson Comorbidity Index Score of 6.8 (2.6). Discordance was identified in 63/165 (38%) and 27/164 (16%) patients in groups I and II respectively. 42/194 patients (21%) did not want cardiopulmonary resuscitation (CPR) and 15/36 (41%) did not prefer intensive care unit (ICU) admission, despite these having been indicated in their initial preferences. 93% (84/90) of patients with discordance preferred de-escalation of care. Discordance was reconciled in 77% (69/90) of patients.

conclusionHospitalized patients may have preferences documented for CPR and ICU interventions contrary to their preferences. Trained nurses can identify inpatients who would benefit from further in-depth resuscitation preference conversations. Once identified, discordance can be reconciled during the index admission.

Indexed as

Cardiopulmonary ResuscitationQuality ImprovementCommunicationDecision MakingHumansPatient PreferenceResuscitation Ordersadvance care planningcardiopulmonary resuscitationdiscordanceintensive care unitresuscitation preferenceshared decision-making

Identifiers

PMID33452662

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.