A Randomized Trial of Shared Decision-Making in Code Status Discussions
Becker C, et al. NEJM Evid. 2025 May;4(5):EVIDoa2400422. doi: 10.1056/EVIDoa2400422.
Methodology: 3.5/5
Usefulness: 3.5/5
Question and Methods: This multi-centre cluster-RCT investigated the effect of didactic teaching, observation + feedback, and a decision aid tool vs. usual care on patients’ goals of care discussions.
Findings: Patients in the intervention group were more likely to elect for DNR status (1.34 [95% CI 1.25-1.50]), with less uncertainty regarding their decision (0.65 [0.54-0.78]).
Limitations: Both groups had significant lost to follow up rates. This study was targeted at Internal Medicine residents and may not be fully applicable to the Emergency Department.
Interpretation: Structured education for goals of care has the potential to facilitate goal-concordant code status decisions, but adaptation to ED must be explored.
Click on the links to read more about; goals of care discussions, and goals of care framework.
