Use of the Electronic Medical Record to Screen Code Status Preference Using Death Language (CODE-EMRS)

Choice of Diction's Effect: Electronic Measures of Resuscitation Status Inpatient

In order to systematically improve code status communication and documentation while clarifying how providers understand code status decisions, we propose the Choice of Diction's Effect Electronic Measures of Resuscitation Study Inpatient (CODE-EMRS.I) with 3 aims: Aim 1 - Determine rate of patient utilization of code status invitation (research) via the Portal (Hypothesis 1: Participants with an existing Portal are more likely to participate in research than new signups); Aim 2 - Evaluate different phrasings in code status prompts with and without death language (Hypothesis 2: Participants are more likely to pick no code with death language than without); Aim 3 - Determine how objective data drives physician agreement on code status decision (Hypothesis 3: Physicians are more likely to disagree with full code decisions for poor GO-FAR, but not CCI). Participants will fill out all study questionnaires electronically, but have options within these to ask to speak to a study physician/their own physician for clarification. After completing the surveys, the research associate will deliver the patient's code status decision to the attending of record and ask their views on it. Once a week, participants who have expressed interest in the study (by clicking the "I am interested" button) but have not completed the study will receive a reminder to complete the study as well as an offer to withdraw from the study in that same communication.

Study Overview

• Status: Recruiting
• Conditions: Code Status Discussions With Medical In-patients
• Intervention / Treatment: Behavioral: Death language

• Study Type: Interventional
• Enrollment (Estimated): 118
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Karthik J Kota, MD MPH; Phone Number: 732-235-7112; Email: karthik.kota@rutgers.edu

Study Locations

• United States
  • New Jersey
    • New Brunswick, New Jersey, United States, 08901
      • Recruiting
      • Robert Wood Johnson University Hospital - New Brunswick
      • Contact: Karthik Kota, MD MPH; Phone Number: 732-235-7112; Email: karthik.kota@rutgers.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age >65, English-fluency in reading and speaking, and the capacity to consent

Exclusion Criteria:

• Requiring ICU-level care

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental/Death language; Participants will be asked: The purpose of this trial is to understand how the words we use to describe CPR affect patient decisions. Cardiopulmonary resuscitation (CPR) is performed when the heart stops beating. It consists of electric shocks to the heart, pumping the chest to circulate blood, and using a breathing machine to help with breathing. The success rate of CPR is about 1 in 7, and even when the heart restarts, the brain and other organs can be damaged. If your heart were to stop beating and you were to die without resuscitation, would you prefer that we attempt cardiopulmonary resuscitation (CPR), or would you prefer that we do not resuscitate (DNR)?	Behavioral: Death language; We will explicitly mention death when letting the participant know about CPR
No Intervention: Standard/non-death language; Participants will be asked: The purpose of this trial is to understand how the words we use to describe CPR affect patient decisions. Cardiopulmonary resuscitation (CPR) is performed when the heart stops beating. It consists of electric shocks to the heart, pumping the chest to circulate blood, and using a breathing machine to help with breathing. The success rate of CPR is about 1 in 7, and even when the heart restarts, the brain and other organs can be damaged. If your heart were to stop beating, would you prefer that we attempt cardiopulmonary resuscitation (CPR), or would you prefer that we do not resuscitate (DNR)?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Code status decision	At enrollment
Physician of record decision for and agreement with code status	Within 24 hours of patient decision

Collaborators and Investigators

• Sponsor: Rutgers, The State University of New Jersey
• Investigators: Principal Investigator: Karthik J Kota, MD MPH, Assistant Professor of Medicine

Study record dates

Study Major Dates

• Study Start (Estimated): February 9, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: February 5, 2026
• First Submitted That Met QC Criteria: February 5, 2026
• First Posted (Actual): February 12, 2026

Study Record Updates

• Last Update Posted (Actual): February 12, 2026
• Last Update Submitted That Met QC Criteria: February 5, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: CPR; EMR; Code status; Death language
• Other Study ID Numbers: Pro2025000307

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: De-identified individual participant data will be made available upon request to the Department of Medicine and approval of the data elements by appropriate regulatory elements in the Department

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No