Navigate Up
UPMC/University of Pittsburgh Schools of the Health Sciences
For Journalists
Manager
Telephone: 412-864-4151
Media Coordinator
Telephone: 412-647-6190
Other Inquiries


Doctor’s Choice of Words May Influence Family’s Decision to Permit CPR if Critically Ill Patient’s Heart Stops

PITTSBURGH, May 9, 2013 – A physician’s choice of words when talking with family members about whether or not to try cardiopulmonary resuscitation (CPR) if a critically ill patient’s heart stops may influence the decision, according to a study by University of Pittsburgh researchers in the June edition of Critical Care Medicine and now available online. 
 
“It’s long been known that the way a choice is framed can influence people’s decisions,” noted Amber E. Barnato, M.D., M.P.H., M.S., lead author of the study and associate professor of clinical and translational science at the University of Pittsburgh School of Medicine. “Our study shows that the words physicians use may play an important role in determining critical end-of-life decisions.”
 
For this first-of-its-kind study, Dr. Barnato and her team recruited more than 250 adult children or spouses in eight cities: Boston, Atlanta, New York, Los Angeles, San Francisco, Dallas, Denver and Pittsburgh.
 
The participants took part in a Web-based survey involving a hypothetical situation in which a loved one was in the intensive care unit with a 40 percent chance of dying from sepsis, a dangerous bacterial infection. Some subjects were shown a photo of their loved ones to help them imagine the situation and heighten the emotional response. An actor portrayed a physician who held a virtual, interactive meeting with the family member. The “doctor’s” responses varied, using different words for the same scenarios. Additionally, some offered emotional support, and others offered only clinical information.
 
A key finding was that when participants were asked to choose between having their loved ones receive CPR if their hearts should stop — a treatment with a 10 percent chance of successfully reviving them — or the alternative, a “Do Not Resuscitate” (DNR) order, 60 percent chose CPR. When the alternative was described as to “allow natural death” instead of a DNR order, the number choosing CPR dropped to 49 percent.
 
When the actor cited “his own experience” about how most others handled such a situation, family members were more likely to choose what they believed was the common approach. Using more empathic language did not influence CPR choice.
 
“Simple changes of words and perceptions about social norms resulted in large differences in CPR choices,” said Dr. Barnato. “The change in terminology from ‘DNR’ to ‘allow natural death’ already has been implemented in a health system in Texas. This study suggests that the change isn’t just window dressing — it makes a real difference in the choices that people make. We expect that it also may reduce feelings of guilt for choosing against CPR by making family members feel like they are doing something positive to honor their loved one’s wishes at the end of life, rather than taking something away from them.”   
 
Robert M. Arnold, M.D., chief, section of palliative care and medical ethics at the University of Pittsburgh School of Medicine, co-authored the study.
 
The work was funded by the National Institute of Nursing Research.

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com