Table 2.

Examples depicting code status conversation categories

Code Status Transition Process	Example #1	Example #2	Example #3
Preemptive conversations before clinical change	“[When asked about] code status, patient states he has form in his bag. Is DNR/DNI” (On routine admission).	(During routine palliative care visit during reinduction admission) “[Patient] raised topic of changing code status to DNR/DNI. He has been thinking about it for some time […] [Patient] doesn’t believe that resuscitation would provide any improvement in his quality of life, and given his poor prognosis, he would prefer to change code status to DNR/DNI.”	“Discussed, informally, code status. Can readdress with [primary oncologist], but she clearly stated her wish to be DNR/DNI.”
Anticipatory conversations at the time of acute clinical deterioration	“We reviewed her course thus far and acknowledged a very low chance of long-term success given her current situation. I outlined all options for care. We agreed to continue with current measures [but that] at this point that heroic measures such as CPR and intubation would not be in her best interests.”	“Held family meeting in light of [patient’s] acute change in clinical status. He has developed bacteremia with GPC [and] increased GI bleeding overnight.[…] Minimally arousable this AM. Family in agreement that if his condition worsens, that [patient] would not want to be transferred to the MICU for pressors or intubation. They also do not want him to undergo CPR or shock in the event of a cardiac arrest. They agree that we should continue all current measures, including antibiotics, blood products, and supportive care, in hopes that he will rebound from current infection.”	“We reviewed the treatment for his leukemia […] Unfortunately, he has developed progressive pulmonary infection [and] he is also developing renal dysfunction. It is possible that his clinical status may deteriorate. We reviewed options, including intubation vs if [he] opts for noninvasive means of therapy […] We discussed we support whatever decision he would like to proceed with. [Patient] opted for DNR/DNI status and would like to continue all noninvasive medical measures at this time.”
Informative conversations after acute clinical deterioration	“Pt is critically ill and may be dying. Team met with family yesterday, who understand this and have changed his code status to DNR”	“Prognosis is markedly poor now that WBC is rising […] I brought up that CPR, shocks, intubation would not meaningfully change prognosis if she were to have an arrest and would potentially cause suffering. She asked us not to pursue those measures.”	“I met with [patient] and his family today to review his hospital course to date [and] the results of the bone marrow biopsy, which are highly suggestive of disease recurrence. I explained that he is too debilitated to receive additional chemotherapy. We discussed that [he] wishes to return home for Christmas. We agreed that at this point, we will work on getting [him] home as soon as possible […] He wishes to be DNR.”