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Background: Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients. Objective: To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care. Design: Open-label randomized controlled trial. Patients: Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed. Intervention: Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid. Main Measure: The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment. Key Results: We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, − 0.2%) (95% confidence interval − 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0–100 with lower scores reflecting less conflict). Conclusions: Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care. Primary Funding Source: Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization. [ABSTRACT FROM AUTHOR]