CPR-Directive Conversations in the Emergency Department: The Opinion of Elderly Patients

Abstract

Background: The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions. Objectives: This study aimed to determine which healthcare professionals elderly patients admitted via the ED preferred to discuss their CPR-directive with and their opinion about the ED as a setting for discussing their CPR-directive. Methods: A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients who indicated that they preferred to discuss their CPR-directive conversation with a physician working in the ED were invited for follow-up semi-structured interviews. Results: General practitioners (GP) were the most preferred healthcare professionals for a conversation about CPR-directives (64%). However, physicians working in the ED were the second most preferred medical professionals (51%) together with medical specialists (51%). Only 6% of patients did not consider a physician in the ED as a suitable option for these conversations. Interviewed patients saw a physician consultation in the ED as an opportunity to: 1) check and update their CPR-directive, 2) get information about the content and consequences of CPR considering their current health status, and 3) prevent the use of undesired medical treatment during admission. Conclusions: Although GPs were the most preferred healthcare professionals with whom to discuss CPR preferences, an unexpectedly large proportion of the investigated population preferred to discuss their choices with a physician working in the ED. These patients considered these discussions to be a crucial part of patient-centered healthcare.