Objectives\nIn the context of serious or life-limiting illness, pediatric patients and their families are faced\nwith difficult decisions surrounding appropriate resuscitation efforts in the event of a cardiopulmonary\narrest. Code status orders are one way to inform end-of-life medical decision\nmaking. The objectives of this study are to evaluate the extent to which pediatric providers\nhave knowledge of code status options and explore the association of provider role with\n(1) knowledge of code status options, (2) perception of timing of code status discussions,\n(3) perception of family receptivity to code status discussions, and (4) comfort carrying out\ncode status discussions.\nDesign\nNurses, trainees (residents and fellows), and attending physicians from pediatric units\nwhere code status discussions typically occur completed a short survey questionnaire\nregarding their knowledge of code status options and perceptions surrounding code status\ndiscussions.\nSetting\nSingle center, quaternary care childrenââ?¬â?¢s hospital.\nMeasurements and main results\n203 nurses, 31 trainees, and 29 attending physicians in 4 high-acuity pediatric units\nresponded to the survey (N = 263, 90% response rate). Based on an objective knowledge\nmeasure, providers demonstrate poor understanding of available code status options, with\nonly 22% of providers able to enumerate more than two of four available code status\noptions. In contrast, provider groups self-report high levels of familiarity with available code\nstatus options, with attending physicians reporting significantly higher levels than nurses\nand trainees (p = 0.0125). Nurses and attending physicians show significantly different perception of code status discussion timing, with majority of nurses (63.4%) perceiving discussions\nas occurring ââ?¬Å?too lateââ?¬Â or ââ?¬Å?much too lateââ?¬Â and majority of attending physicians\n(55.6%) perceiving the timing as ââ?¬Å?about rightââ?¬Â (p 0.0001). Attending physicians report significantly\nhigher comfort having code status discussions with families than do nurses or trainees\n(p0.0001). Attending physicians and trainees perceive families as more receptive to\ncode status discussions than nurses (p 0.0001 and p = 0.0018, respectively).\nConclusions\nProviders have poor understanding of code status options and differ significantly in their\ncomfort having code status discussions and their perceptions of these discussions. These\nfindings may reflect inherent differences among providers, but may also reflect discordant\nvisions of appropriate care and function as a potential source of moral distress. Lack of\nknowledge of code status options and differences in provider perceptions are likely barriers\nto quality communication surrounding end-of-life options.
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