CODE
Trial question
What is the role of coaching doctors regarding ethical decision-making to improve goal-oriented care in adult hospitalized patients potentially receiving excessive treatment?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
45.0% female
55.0% male
N = 6614
6614 patients (3003 female, 3611 male).
Inclusion criteria: adult hospitalized patients potentially receiving excessive treatment.
Interventions
N=4012 coaching (coaching for at least 1 month).
N=2602 usual care (coaching for < 1 month or usual care).
Primary outcome
Provision of written do-not-intubate and do-not-attempt-cardiopulmonary-resuscitation orders in patients potentially receiving excessive treatment
29.7%
19.6%
29.7 %
22.3 %
14.8 %
7.4 %
0.0 %
Coaching
Usual
care
Significant
increase ▲
NNT = 9
Significant increase in provision of written DNI and DNACPR orders in patients potentially receiving excessive treatment (29.7% vs. 19.6%; OR 4.24, 95% CI 4.21 to 4.27).
Secondary outcomes
Significant increase in death at 1 year in patients potentially receiving excessive treatment (85% vs. 83.7%; HR 2.76, 95% CI 1.26 to 6.04).
No significant difference in mean Ethical Decision-Making Climate Questionnaire score (0.45 points vs. 0.47 points; MD 0.025, 95% CI -0.18 to 0.23).
Significant increase in written DNI and do-not attempt CPR orders, overall population (3.4% vs. 1.9%; OR 1.65, 95% CI 1.12 to 2.43).
Conclusion
In adult hospitalized patients potentially receiving excessive treatment, coaching was superior to usual care with respect to provision of written DNI and DNACPR orders in patients potentially receiving excessive treatment.
Reference
Dominique D Benoit, Aglaja De Pauw, Celine Jacobs et al. 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. 2024 Oct;50(10):1635-1646.
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