(Press-News.org) 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.
About the University of Pittsburgh Schools of the Health Sciences
The University of Pittsburgh Schools of the Health Sciences include the schools of Medicine, Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences and the Graduate School of Public Health. The schools serve as the academic partner to the UPMC (University of Pittsburgh Medical Center). Together, their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care. Since 1998, Pitt and its affiliated university faculty have ranked among the top 10 educational institutions in grant support from the National Institutes of Health. For additional information about the Schools of the Health Sciences, please visit http://www.health.pitt.edu.
http://www.upmc.com/media
Doctor's choice of words may influence family's decision to permit CPR in critically ill
2013-05-09
ELSE PRESS RELEASES FROM THIS DATE:
Laughter perception networks in brain different for mocking, joyful or ticklish laughter
2013-05-09
A laugh may signal mockery, humor, joy or simply be a response to tickling, but each kind of laughter conveys a wealth of auditory and social information. These different kinds of laughter also spark different connections within the "laughter perception network" in the human brain depending on their context, according to research published May 8 in the open access journal PLOS ONE by Dirk Wildgruber and colleagues from the University of Tuebingen, Germany.
Laughter in animals is a form of social bonding based on a primordial reflex to tickling, but human laughter has ...
Brain, not eye mechanisms keep color vision constant across lifespan
2013-05-09
Cone receptors in the human eye lose their color sensitivity with age, but our subjective experience of color remains largely unchanged over the years. This ability to compensate for age-related changes in color perception rests in higher levels of the visual system, according to research published May 8 in the open access journal PLOS ONE by Sophie Wuerger from the University of Liverpool, UK.
The study included 185 participants aged 18 to 75 years with normal color vision, and revealed that the appearance of color remains largely unaffected by known age-related changes ...
In ancient China, sago palms were major plant food prior to rice cultivation
2013-05-09
Before rice cultivation became prevalent, ancient populations on the southern coast of China likely relied on sago palms as staple plant foods, according to research published May 8 in the open access journal PLOS ONE by Xiaoyan Yang and colleagues from the Chinese Academy of Sciences in Beijing, China.
Little is known about prehistoric diets of those who lived in southern subtropical China, as the acidic soils and humid climate of the region cause poor preservation of plant remains. Though literature and archaeological discoveries have suggested that roots and tubers ...
Astronomers discover surprising clutch of hydrogen clouds lurking among our galactic neighbors
2013-05-09
In a dark, starless patch of intergalactic space, astronomers have discovered a never-before-seen cluster of hydrogen clouds strewn between two nearby galaxies, Andromeda (M31) and Triangulum (M33). The researchers speculate that these rarefied blobs of gas -- each about as massive as a dwarf galaxy -- condensed out of a vast and as-yet undetected reservoir of hot, ionized gas, which could have accompanied an otherwise invisible band of dark matter.
The astronomers detected these objects using the National Science Foundation's Green Bank Telescope (GBT) at the National ...
Immune cells that suppress genital herpes infections identified
2013-05-09
SEATTLE – Fred Hutchinson Cancer Research Center and University of Washington scientists have identified a class of immune cells that reside long-term in the genital skin and mucosa and are believed to be responsible for suppressing recurring outbreaks of genital herpes. These immune cells also play a role in suppressing symptoms of genital herpes, which is why most sufferers of the disease are asymptomatic when viral reactivations occur.
The discovery of this subtype of immune cells, called CD8αα+ T cells, opens a new avenue of research to develop a vaccine ...
Discovery of gene mutation causing Sturge-Weber syndrome, port-wine stain birthmarks offers new hope
2013-05-09
(Baltimore, MD) – In new findings published on May 8, 2013 in the New England Journal of Medicine (Epub ahead of print), researchers from the Kennedy Krieger Institute reveal the discovery of the cause – a genetic mutation that occurs before birth – of Sturge-Weber syndrome (SWS) and port-wine stain birthmarks. SWS is a rare disorder affecting approximately one in 20,000 births, while port-wine birthmarks are more common, affecting approximately one million individuals in the United States.
"This is a complete game changer for those with Sturge-Weber syndrome and the ...
Lucky bacteria strike it rich during formation of treatment-resistant colonies
2013-05-09
In biology, we often think of natural selection and survival of the fittest. What about survival of the luckiest?
Like pioneers in search of a better life, bacteria on a surface wander around and often organize into highly resilient communities, known as biofilms. It turns out that a lucky few bacteria become the elite cells that start the colonies, and they organize in a rich-get-richer pattern similar to the distribution of wealth in the U.S. economy, according to a new study by researchers at UCLA, Northwestern University and the University of Washington.
The study, ...
Fun and friends help ease the pain of breast cancer
2013-05-09
OAKLAND, Calif., May 9 — Breast cancer patients who say they have people with whom they have a good time, or have "positive social interactions" with, are better able to deal with pain and other physical symptoms, according to a new Kaiser Permanente study published today in Breast Cancer Research and Treatment.
"This study provides research-based evidence that social support helps with physical symptoms," said lead author Candyce H. Kroenke, ScD, MPH, staff scientist with the Kaiser Permanente Division of Research. "Social support mechanisms matter in terms of physical ...
New Red List developed for threatened ecosystems
2013-05-09
Scientists have developed a new Red List system for identifying ecosystems at high risk of degradation, similar to the influential Red List for the world's threatened species.
The team carrying out the research was convened by the International Union for Conservation of Nature and led by Professor David Keith, of the University of New South Wales and the NSW Office of Environment.
The study, which illustrates how the framework for risk assessment applies to 20 ecosystems around the world, including eight in Australia, is published today in the Public Library of Science ...
Engineered spider toxin could be the future of anti-venom vaccines
2013-05-09
Amsterdam, May 9, 2013 - New engineered spider protein could be the start of a new generation of anti-venom vaccines, potentially saving thousands of lives worldwide. The new protein, created from parts of a toxin from the reaper spider, is described today in the Elsevier journal Vaccine.
The researchers behind the study, from the Universidade Federal de Minas Gerais in Brazil, say that the engineered protein may be a promising candidate for developing therapeutic serums or vaccines against other venoms.
Reaper spiders, or brown spiders, are a family of species found ...