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Can Millennials Talk About Death? Young Adults' Perceptions of End-of-Life Care

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Does death confront the young as an incomprehensible force or can it be talked about? And what are the implications for health administration education? These questions serve as the impetus behind the present study, which is the rst known a empt to document young adults’ perceptions of end-of-life care. Descriptive data were gathered from 84 “millennials” (age 18-34), yielding important insights on this generation’s willingness to have end-of-life care conversations, their trust in the U.S. healthcare system when it comes to end- of-life care, their religious and cultural in uences informing their views of death and dying, and their own advance care planning wishes. Findings sug- gest that millennials are willing to discuss end-of-life care options, and death and dying more generally, challenging the stereotype of denial, avoidance, and self-centeredness that have perennially plagued the young. Implications for health administration education are discussed.
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Young adults’ perceptions of end-of-life care 23
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24 The Journal of Health Administration Education Winter 2017
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

       


   


 



   

 



   

Young adults’ perceptions of end-of-life care 25

 
  



  



 


Technology and self-expression
        




 


  


  





Diversity and values
          
        


26 The Journal of Health Administration Education Winter 2017



 







Institutional distrust and stress










 






Physical health
   





   

Young adults’ perceptions of end-of-life care 27

  

    








 
        



Clinician perspectives








          



Patient and family perspectives






28 The Journal of Health Administration Education Winter 2017



       





Cultural inuences



 

          


  
 

   



 









Young adults’ perceptions of end-of-life care 29

         


    

 nn

nn
nn
nn
  

  


   





Millennials as a whole




 






30 The Journal of Health Administration Education Winter 2017


  N



  
  



  
  
  




  
  
  




  
  
  




  
  
  
 

        
        



  N



  
  
  



  
  
  
Young adults’ perceptions of end-of-life care 31
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 
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
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  N
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  
  
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  
  
  
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  
  
  
        


  
32 The Journal of Health Administration Education Winter 2017



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  N
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  
  

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  
  
  
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
  
  
  

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
  
  
  
  
Cultural variations

 n 
nn


 



    

      


Young adults’ perceptions of end-of-life care 33
       

 

  

   

  




    
   




 



    











34 The Journal of Health Administration Education Winter 2017


  


 


   
   
   



   .002**
   .000**
   



   .036*
   .000**
   .043*



   .017*
   
   

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
   
   
   .000**



   .007**
   
   

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
   
   
   


   
   .049*
   


   
   .023*
   

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Young adults’ perceptions of end-of-life care 35
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   
   
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   
   
   
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   
   
   
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
       
         

 




cont.
36 The Journal of Health Administration Education Winter 2017
    
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
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






 








 


 





 



         
        
   
Young adults’ perceptions of end-of-life care 37


  




 


 






Combating ageism










     








38 The Journal of Health Administration Education Winter 2017
     


   







The business of dying

          

   

  



 

        

 














Young adults’ perceptions of end-of-life care 39
Cultural dimensions to end-of-life care








        
  



 
  
         






         




 

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40 The Journal of Health Administration Education Winter 2017

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Journal
of the American Medical Association, 275
Stressed in America: Paying with
our health
Psychological testing (7th ed.)
 

 
Journal of Business and Psychology, 35
Young adults’ perceptions of end-of-life care 41

 
 
 Journal of the American Medical Association, 315

 Journal of the American Medical
Association, 274
Cultural issues in end-of-life
decision making

Generations, 40

On death and dying (pp. xi-xv)

 Journal of American Health Policy, 2
Asian American religions: The making and
remaking of borders and boundaries

 
 

 
Critical Care Medicine, 31
Respecting cultural dierences at
the end of life
 

Hungton Post
42 The Journal of Health Administration Education Winter 2017
Journal of
Business and Psychology, 25
The state of young Americans: Economic barriers to the American
dream (The Databook)

 Educational Gerontology,
36
Prosumer Report | Gender shift: Are women the
new men?
Approaching death
 

 Professional Case Management, 21

 
Journal of Nursing Education, 35
American millennials: Deciphering
the enigma generation.
 

 Journal of Palliative Medicine

 Organizational Analysis, 12

 
 Social Science & Medicine, 60

 
 International Journal of Hospitality Management, 27
Young adults’ perceptions of end-of-life care 43

 
 
 

 

 Nursing
Education Today, 32

 USA Today

 
 Annals of Internal Medicine, 127
Journal of the
American Geriatrics Society, 48
Millennials Rising. 
Ethic variations in dying,
death, and grief

 Proceedings of the
Joint Statistical Meetings of the American Statistical Association, Section on
Survey Research Methods
 

Journal of the American Medical Association, 286
The networked nonprot: Connecting with social
media to drive change
44 The Journal of Health Administration Education Winter 2017
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 
 Cancer, 116
On death & dying

 Journal of Family Practice, 39

 
Gerontology and Geriatrics Education, 27

Maternal Child Nursing, 15
The war on learning: Gaining ground in the digital university.

 Medicine as culture: Illness, disease and the body in western
societies.

 Industrial and Commercial
Training, 37
National Center for Health
Statistics: Births in the United States, 2013
 

 
 Journal of
General Internal Medicine, 17

 
 Education, Citizenship and Social Justice, 10
Young adults’ perceptions of end-of-life care 45

 
 Patient Education and Counseling, 99
 

 Survey nonresponse

Forbes.
The net delusion: The dark side of internet freedom.
 

 
Archives of Internal Medicine, 158
Oncology
Nursing Forum, 25

 Journal of Law, Medicine & Ethics,
24

 
Health Aairs, 34

 Analysis of medicare spending by age for beneciaries in
traditional medicare
 
 
How we die
 

 Death Studies, 22
46 The Journal of Health Administration Education Winter 2017
Project on Death in America: Report of activities,
January 2001 - December 2003

 
Archives of Internal Medicine, 161
A study of the relationship between generational group
identication and organizational commitment: Generation X vs. Generation Y
 
 

 


 
 

 

 
 
The quarter-life breakthrough.
 
Classroom communication and diversity:
Enhancing instructional practice
The
American freshman: National norms fall 2011.
 

 
Critical Care Medicine, 34
Young adults’ perceptions of end-of-life care 47

 Health Services Research, 45

 Educational Gerontology, 32

 
Journal of Immigrant Health, 7

 
 Teaching Sociology, 40

 Journal of the American Medical Association, 281
Unequal treatment: Confronting
racial and ethnic disparities in health care
 
Does gender inuence online survey participation? A record-
linkage analysis of university faculty online survey response behavior



 Journal of the American Medical
Association, 284
The Surgeon General’s vision for a healthy and t nation
 

 
Journal of the American Medical Association, 291

 Journal of
the American Medical Association, 309
48 The Journal of Health Administration Education Winter 2017

The Atlantic

 
 
Critical Care Medicine, 36

 Medical Education, 43

 
The millennial generation: Research review.
 
Cross-cultural perspectives in medical ethics.
 

 
 Obesity, 16

 Currents in
Teaching and Learning, 1

 Ethnic variations in dying, death
and grief
... Despite an upsurge in death education in the United States over the past half century, thinking and talking about death has been considered irrelevant or even morbid, especially for young people (Gerard, 2017). This situation may be due in part to the assumption that thinking about death prompts psychological discomfort for young adults, as it reminds them that their lifetime is limited. ...
... Emanuel, Fairclough, Wolfe, & Emanuel, 2004;Mori et al., 2017) and to the clarification of life values and reduction of anxiety in healthy adults (e.g. Llewellyn et al., 2016;Yuan et al., 2019), including young adults (Gerard, 2017). Not thinking about death, in contrast, has drawbacks: avoiding the topic affects the likelihood of preparing for death, including participation in advance care planning (ACP). ...
... Historically, young adults have seldom been encouraged to consider death and dying (Gerard, 2017) partly because of the societal notion that exposure to death is not normative in this life phase (e.g. that fewer deaths occur for young adults than middleaged or older adults; Balk, 1996). Recent work, however, suggests that young adults have thought extensively about death and dying and are willing to engage in further exploration (Tripken & Elrod, 2018). ...
Article
We investigated how death attitudes and experience relate to perspectives on advance care planning (ACP) in young adulthood, and whether attending a Death over Dinner event affects perspectives on ACP. Participants (N = 109) were assigned to a Death over Dinner or waitlist control condition, completing pretest and post-test measures. Higher Death Rejection and having more Experience with Death predicted Reservations about ACP. Participation in a Death over Dinner decreased Reservations toward ACP compared to the control group. Death over Dinner appears to be useful in ameliorating reservations toward ACP without shortening individuals’ sense of their time left to live.
... Many millennials witnessed their parents unceremoniously let go after putting in decades of time with a company (Brownstein, 2010), throwing into question the value of organizational loyalty and the purpose of work (Patalano, 2008). Research has also shown millennial distrust directed at politics (Foa and Mounk, 2016), education (Selingo, 2013) and the US healthcare system (Gerard, 2017a). ...
... Cronbach's alpha statistic was used to assess the internal consistency of both the MWMS and prosocial motivation survey items. Of the six motivation types measured in the MWMS, three reported acceptable alpha coefficients above 0.7 (George and Mallery, 2003), namely, amotivation (a = 0.86), social extrinsic regulation (a = 0.73) and intrinsic motivation (a = 0.89). The remaining three motivation types of material extrinsic regulation (a = 0.40), introjected regulation (a = 0.58), and identified regulation (a = 0.66) produced low alpha coefficients and were not considered in subsequent analyses. ...
Article
Full-text available
Purpose: While considerable scholarly attention has been given to “millennials” (those born between 1981 and 1997), little is known of this generation’s ability to influence healthcare organizations and managerial roles in particular. This paper aims to clarify why millennials enter the healthcare management field and how their motivations correlate with preferences for working in various healthcare sectors and with various patient populations. Design/methodology/approach: Survey data were collected from 107 millennials pursuing bachelor degrees in healthcare management by using a modified version of the multidimensional work motivation scale. Further data were collected on millennials’ preferences for working in various healthcare sectors and with various patient populations. Correlational analyses were conducted to examine the relationship between types of motivation and workplace preferences. Cross-cultural differences were also examined within this generational set. Findings: Results indicate a significant positive relationship between intrinsic motivation and preferences for working on the payer side of the industry and within finance and IT functions. Findings also reveal a significant positive relationship between prosocial motivation and preferences for working with more vulnerable patient populations. Variance in work motivation among cultural sub-sets of millennials suggests different upbringings, or alternatively, cultural relativity of the motivational constructs themselves. Research limitations/implications: Despite offering key insights into the next generation of healthcare managers, this study is limited by a sample of millennials from one large, metropolitan university in the USA and thus may not represent the views of all millennials. Practical implications: To select, retain and develop the next generation of healthcare managers, it is incumbent upon organizations to better understanding millennials’ motivations and preferences. Originality/value: This study is the first of its kind to illuminate the motivations and preferences that underpin a key and growing segment of the healthcare workforce. Millennials, now the largest and most diverse generation on the planet, are poised to change the landscape of health care.
... Besides persons with life-limiting illness, healthy and younger individuals can also benefit from EOL conversations (Gerard, 2017). Dealing with one's own mortality can lead to a reduction of death-related fears (Llewellyn et al., 2016;Mroz et al., 2022), increased insight into expressed end-of-life wishes (Lambert South & Elton, 2017;Llewellyn et al., 2016) as well as clarification of one's personal values in life (Mroz et al., 2022). ...
Article
Full-text available
End-of-life (EOL) conversations with relatives or significant others are often avoided. One reason can be negative expectations regarding these conversations. The present study was conducted to develop and initially validate the End-of-Life Conversations – Expectations Scale (EOLC-E). An exploratory factor analysis ( N = 307) resulted in a 20-item version with three distinct dimensions: expected own emotional burden (α = .92), expected other person’s emotional burden (α = .94) and communication self-efficacy (α = .89). The EOLC-E total score correlated significantly with communication apprehension about death ( r = .62), fear of death ( r = .58), death avoidance ( r = .52) as well as readiness for end-of-life conversations ( r = −.38) and occurrence of previous conversations ( r = −.29). Results suggest that the EOLC-E is a reliable and valid instrument to assess death and dying communication expectations. This measure has utility in communication research focusing on optimizing expectations and increasing EOL communication.
... Societies fall somewhere on a continuum of "death welcoming" to "death denying" (DeSpelder et al., 2015). As some scholars have noted (e.g., Kellehear, 2007;Lee, 2008), the United States is experiencing a subtle shift away from being a death-denying society, as recent studies have demonstrated greater openness to death (Coombs, 2014;Gerard, 2017;Omilion-Hodges et al., 2019) than previously acknowledged. Although it remains uncommon to discuss death and dying unless there is an imminent reason, individuals are increasingly exposed to content related to death and dying through the media (Coombs, 2014). ...
Article
Advance care planning (ACP) is atypical in the United States, especially among young adults. We designed and evaluated the effectiveness of a brief intervention about the benefits of perceived control and planning for end-of-life. Participants (N = 188) were randomized into three conditions and completed a cross-sectional questionnaire. Participants who received the intervention were less likely to worry about not getting enough care and more likely to anticipate completing verbal and written ACP within three months than were comparison group participants. Findings suggest the potential of brief interventions to raise awareness about the benefits of ACP and enhance completion among young adults.
... Vignettes serve as tools for extending discussions of issues underlying the scenarios and for collecting 'situated data' concerning collective values, beliefs, norms and behaviours [32]. Vignettes are used in research across various topics, including domestic violence and abuse [33], experience of physical exercise [34], end-oflife care [35] and risks [36]. ...
Conference Paper
Growing amounts of research on IoT and its implications for security, privacy, economy and society has been carried out to inform policies and design. However, ordinary people who are citizens and users of these emerging technologies have rarely been involved in the processes that inform these policies, governance mechanisms and design due to the institutionalised processes that prioritise objective knowledge over subjective ones. People's subjective experiences are often discarded. This priority is likely to further widen the gap between people, technology policies and design as technologies advance towards delegated human agencies, which decreases human interfaces in technology-mediated relationships with objects, systems, services, trade and other (often) unknown third-party beneficiaries. Such a disconnection can have serious implications for policy implementation, especially when it involves human limitations. To address this disconnection, we argue that a space for people to meaningfully contribute their subjective knowledge - experienceto complex technology policies that, in turn, shape their experience and well-being needs to be constructed. To this end, our paper contributes the design and pilot implementation of a method to reconnect and involve people in IoT security policymaking and development.
... Following the tradition of applied drama and drama in education, these scenarios are designed to ease participants into an exchange of their digital experience, which may be frustrating and embarrassing, rather than diving straight in. Vignettes are found to be particularly useful in prompting reflective responses from young people and in discussions of sensitive subjects in various areas, ranging from domestic violence and abuse (Bradbury-Jones, Taylor and Herber 2014) to experience of physical exercise (Yungblut et al. 2012) and perceptions concerning end-of-life care (Gerard 2017). ...
Article
Young people aged between 12 and 17 across three major British cities — London, Leeds and Nottingham — were invited to play the role of ‘jurors’ on a case where ‘the Internet was put on trial’. The recommendations reported in this paper are intended to improve digital experience and online safety as contributions to policy. These recommendations derive from the ‘youth jurors’ policy deliberations designed to encourage young people to reflect on their digital experience and collectively develop their own problem definitions and solutions.
Article
A dramatic shortage of healthcare workers jeopardizes our capacity to deliver expert eldercare now and moving forward. The Geriatrics Workforce Enhancement Program (GWEP) addresses that need. The GWEP combines and replaces previous Health Resources and Services Administration geriatrics programs to advance education, training, and clinical care. An array of organizations received the first round of funding in 2015, and they will work to address critical issues while building collaborations with community-based partners. A new John A. Hartford Foundation GWEP Coordinating Center, administered by the American Geriatrics Society, also will strive to support GWEP sites and the national GWEP collective.
Article
Purpose and objectives: This article: PRIMARY PRACTICE SETTINGS(S):: Applicable to all health care sectors where case management is practiced. Findings/conclusion: Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Implications for case management practice: Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.
Article
Importance Differences in utilization and costs of end-of-life care among developed countries are of considerable policy interest.Objective To compare site of death, health care utilization, and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway, and the United States.Design, Setting, and Participants Retrospective cohort study using administrative and registry data from 2010. Participants were decedents older than 65 years who died with cancer. Secondary analyses included decedents of any age, decedents older than 65 years with lung cancer, and decedents older than 65 years in the United States and Germany from 2012.Main Outcomes and Measures Deaths in acute care hospitals, 3 inpatient measures (hospitalizations in acute care hospitals, admissions to intensive care units, and emergency department visits), 1 outpatient measure (chemotherapy episodes), and hospital expenditures paid by insurers (commercial or governmental) during the 180-day and 30-day periods before death. Expenditures were derived from country-specific methods for costing inpatient services.Results The United States (cohort of decedents aged >65 years, N = 211 816) and the Netherlands (N = 7216) had the lowest proportion of decedents die in acute care hospitals (22.2.% and 29.4%, respectively). A higher proportion of decedents died in acute care hospitals in Belgium (N = 21 054; 51.2%), Canada (N = 20 818; 52.1%), England (N = 97 099; 41.7%), Germany (N = 24 434; 38.3%), and Norway (N = 6636; 44.7%). In the last 180 days of life, 40.3% of US decedents had an intensive care unit admission compared with less than 18% in other reporting nations. In the last 180 days of life, mean per capita hospital expenditures were higher in Canada (US $21 840), Norway (US $19 783), and the United States (US $18 500), intermediate in Germany (US $16 221) and Belgium (US $15 699), and lower in the Netherlands (US $10 936) and England (US $9342). Secondary analyses showed similar results.Conclusions and Relevance Among patients older than 65 years who died with cancer in 7 developed countries in 2010, end-of-life care was more hospital-centric in Belgium, Canada, England, Germany, and Norway than in the Netherlands or the United States. Hospital expenditures near the end of life were higher in the United States, Norway, and Canada, intermediate in Germany and Belgium, and lower in the Netherlands and England. However, intensive care unit admissions were more than twice as common in the United States as in other countries.
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Teachers face myriad communication challenges in today's classroom, reflecting the growing diversity of the student body; the ever-increasing number of students; gender issues; and students' learning disabilities. This volume provides a useful framework for helping new and experienced teachers manage the diverse communication challenges they encounter. It also encourages teachers to reflect on how their personal cultures influence their expectations about appropriate classroom communication and ways to demonstrate learning. This textbook is distinctive in its integration of information from a variety of sources to establish a viewpoint that focuses on the needs of the individual learner. Drawing on the research in the communication and education disciplines, authors Robert G. Powell and Dana Caseau provide theoretical models and useful strategies for improving instructional practices. They address the ways in which culture influences communication in the classroom, and assist teachers in developing the skills necessary to meet the needs of the students in their classrooms. Much of the information shared in this text derives from the authors' research and experience in schools and from the experiences of others, including teachers, parents, and children. Their experiences, combined with the cross-disciplinary approach, produce a volume of unique perspectives and considerable insight. Teachers and scholars in the communication and education disciplines will find this text to be a practical and valuable tool for classroom teaching, and it is appropriate for instructional communication courses in the areas of communication and education. © 2004 by Lawrence Erlbaum Associates, Inc. All rights reserved.
Article
Background: Physicians are frequently unaware of patient preferences for end-of-life care. Identifying and exploring barriers to patient-physician communication about end-of-life issues may help guide physicians and their patients toward more effective discussions. Objective: To examine correlates and associated outcomes of patient communication and patient preferences for communication with physicians about cardiopulmonary resuscitation and prolonged mechanical ventilation. Design: Prospective cohort study. Setting: Five tertiary care hospitals. Patients: 1832 (85%) of 2162 eligible patients completed interviews. Measurements: Surveys of patient characteristics and preferences for end-of-life care; perceptions of prognosis, decision making, and quality of life; and patient preferences for communication with physicians about end-of-life decisions. Results: Fewer than one fourth (23%) of seriously ill patients had discussed preferences for cardiopulmonary resuscitation with their physicians. Of patients who had not discussed their preferences for resuscitation, 58% were not interested in doing so. Of patients who had not discussed and did not want to discuss their preferences, 25% did not want resuscitation. In multivariable analyses, patient factors independently associated with not wanting to discuss preferences for cardiopulmonary resuscitation included being of an ethnicity other than black (adjusted odds ratio [OR], 1.48 [95% CI, 1.10 to 1.99), not having an advance directive (OR, 1.35 [CI, 1.04 to 1.76]), estimating an excellent prognosis (OR, 1.72 [CI, 1.32 to 2.59]), reporting fair to excellent quality of life (OR, 1.36 [CI, 1.05 to 1.76]), and not desiring active involvement in medical decisions (OR, 1.33 [CI, 1.07 to 1.65]). Factors independently associated with wanting to discuss preferences for resuscitation but not doing so included being black (OR, 1.53 [CI, 1.11 to 2.11]) and being younger (OR, 1,14 per 10-year interval younger [CI, 1.04 to 1.25]). Conclusions: Among seriously ill hospitalized adults, communication about preferences for cardiopulmonary resuscitation is uncommon. A majority of patients who have not discussed preferences for end-of-life care do not want to do so. For patients who do not want to discuss their preferences, as well as patients with an unmet need for such discussions, failure to discuss preferences for cardiopulmonary resuscitation and mechanical ventilation may result in unwanted interventions.