Communication during Hospitalization About Resuscitation Trial (CHART)
Principal Investigators: J. Randall Curtis (Renee Stapleton)
Research Grant: National Institutes of Health: National Institute on Aging, April 2016 to March 2021
This RCT was implemented at four sites (University of Vermont, Medical University of South Carolina, University of North Carolina – Chapel Hill, and University of Washington) and included patients randomized to either a study physician-directed discussion about CPR using an informed assent framework or usual care. Our long term objectives are to demonstrate that this informed assent approach to discussing CPR in hospitalized, seriously ill, older patients with severe functional impairment, when delivered by trained physician interventionists, improves patient and family outcomes.
Specific Aims
1. Quality of and satisfaction with end-of-life communication. To determine if an informed assent approach to discussing CPR in hospitalized older patients with advanced functional impairment, compared to usual care with an attention control, improves patient- and family-assessed quality of and satisfaction with communication about CPR.
2. Family- and patient-centered symptoms and decisional regret. To determine if this informed assent approach, compared to usual care with an attention control, reduces symptoms of depression, anxiety, and stress as well as decisional regret in patients and family members.
3. Health care utilization and cost. To determine if this informed assent approach, compared to an attention control, increases do not resuscitate (DNR) orders during hospitalization and reduces the time to DNR orders. We will also examine the influence on intensity of care, health care utilization, and costs of care.
clinicaltrials.gov: https://clinicaltrials.gov/show/NCT02984124
Publications from this study include:
Stapleton RD, Ford DW, Sterba KR, Nadig NR, Ades S, Back AL, Carson SS, Cheung KL, Ely J, Kross EK, Macauley RC, Maguire JM, Marcy TW, McEntee JJ, Menon PR, Overstreet A, Ritchie CS, Wendlandt B, Ardren SS, Balassone M, Burns S, Choudhury S, Diehl S, McCown E, Nielsen EL, Paul SR, Rice C, Taylor KK, Engelberg RA. Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients. J Pain Symptom Manage. 2022 Jun;63(6):e621-e632.