Background: Hospitalization of the patient with advanced cancer can be a pivotal moment and opportunity to explore patient goals of care in order to deliver high value, patient-centered care that emphasizes quality of life. Part of this discussion should define patient preferences regarding code status as it is known that prognosis is extremely poor and quality of life diminishes significantly in patients with cancer if they are resuscitated and admitted to the ICU. Studies show that patients largely depend on physicians to initiate end-of-life conversations, and a majority of significantly ill hospitalized patients prefer physician input when making these decisions. Resident physicians often carry out code status discussions. However, limited data exists regarding how often code status is addressed by residents in hospitalized cancer patients and whether any intervention can increase frequency of discussions.

Purpose: We conducted a quality improvement project to assess the frequency of code status discussions between interns and patients on admission, determine intern comfort with code status discussions, and evaluate whether a pocket-sized verbal script for interns and visual decision aid for patients (intervention) on broaching code status discussions improves rates of such discussions.

Description: Prior to our intervention, 19% of interns conducted code status discussions prior to the intervention compared to 45% after the intervention. The most common reason that interns did not have code status discussions was time pressure. Other reasons included inappropriate settings, patient was non-verbal, no expectation for decompensation, and complex social dynamics.

Conclusions: The use of a simple educational tool that included a script for interns and a decision aid for patients resulted in an increase (19% to 45%) in the frequency of code status discussions. Discussing and documenting code status is an important component of medical care.