Coaching doctors to improve ethical decision-making in adult hospitalized patients potentially receiving excessive treatment. The CODE stepped-wedge cluster randomized controlled trial
An erratum to this article was published (Intensive Care Med, Jan 2025 ↗)
Authors' conclusion
This study suggests that coaching doctors regarding ethical decision-making in teams safely improves goal-oriented care operationalized via written DNI-DNACPR decisions in hospitalized patients, however without concomitantly improving the quality of the ethical climate.
Study context
- Population
- Adult hospitalized patients potentially receiving excessive treatment (PET) and clinicians in the medical intensive care unit (ICU) and 9 referring internal medicine departments of Ghent University Hospital, February 2022–February 2023125 PET
- Participants
- 7,254 participants
- Comparison
- Intervention vs Control
- Primary endpoint
- Incidence of written DNI-DNACPR decisions (first primary endpoint); EDMCQ before and after the study period (second primary endpoint)
Methodological detailssingle-centre (ICU and 9 internal medicine departments), 50 of the 93 (53.7%) doctors participated in coaching, mean (SD) 4.36 (2.55) sessions
- Single-centre (ICU and 9 internal medicine departments)
- 50 of the 93 (53.7%) doctors participated in coaching, mean (SD) 4.36 (2.55) sessions
Primary result
As reported in the abstract
Written DNI-DNACPR decisions in PET; EDMCQ
Odds ratio (95% CI)P value
Intervention vs Controlwritten DNI-DNACPR decisions in PET (estimated incidence)
4.24(4.21–4.27)
P < 0.001- After vs Before · EDMCQ; 270 (61%) and 261 (61.7%) clinicians responded
- mean difference 0.02 points (95% CI - 0.18 to 0.23); P = 0.815
Secondary outcomes
| Outcome | Intervention | Control | Estimate | P value | |
|---|---|---|---|---|---|
| Written DNI-DNACPR decisions, overall population (post-hoc analysis)Post-hoc analysis | 3.4% | 1.9% | OR 1.65 (CI 1.12–2.43) | P = 0.011 | |
| Mortality up to 1 year, overall population | 14.5% | 15.1% | HR 0.89 (CI 0.72–1.09) | P = 0.251 | |
| Mortality up to 1 year, PET | 85% | 83.7% | HR 2.76 (CI 1.26–6.04) | P = 0.011 | |
| 0.10.31310Ratio (log scale) |
- Written do-not-intubate and do-not attempt cardiopulmonary resuscitation (DNI-DNACPR) decisions, overall population (post-hoc analysis): 6614 patients analysed
Original publication
Coaching doctors to improve ethical decision-making in adult hospitalized patients potentially receiving excessive treatment. The CODE stepped-wedge cluster randomized controlled trial. Intensive Care Med. Published 4 September 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →