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April 24, 1996

The SUPPORT Project and Improving Care for Seriously III Patients

Author Affiliations

Rush Presbyterian St Lukes Medical Center Chicago, Ill

JAMA. 1996;275(16):1229. doi:10.1001/jama.1996.03530400015022

To the Editor.  — The observational portion of the SUPPORT project1 finds that when interviewed by research nurses, 31% of patients and/or their families preferred that CPR be withheld but only 47% of the interviewed physicians accurately reported this preference during the final interview. On the surface, this information suggests miscommunication and lack of understanding of the wishes of the patient and family. However, this study also found that 79% of all patients who died had a no-CPR order written. Of patients wishing a no-CPR order who died, probably all had no-CPR orders written, and the authors failed to include this important data in their report.The interventional aspect of the SUPPORT project found that providing daily computer probability estimates of patient survival to physicians and hospital staff did not change several "undesirable" outcomes. In interpreting these data, it is important to understand that, based on other data from