Abstract
BackgroundAdvance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions.MethodsTwo focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated ‘Goals of Patient Care’ (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback.ResultsThree key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans.ConclusionThrough an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1803-x) contains supplementary material, which is available to authorized users.
Highlights
Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice
We aimed to explore physician barriers to advance CPR decision-making in the hospital setting and develop a pragmatic intervention to support clinicians to undertake, and document, routine advance care planning discussions
A barrier and enabler analysis results Three themes emerged from the qualitative analysis, identifying where improvements in advance CPR decision-making could be made: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it
Summary
Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Not-for-resuscitation (NFR) orders have been introduced in most countries to prevent the use of CPR in situations when it is deemed futile or unwanted by patients, NFR orders are challenging to complete, performed infrequently or too late to seek patient preferences, and have been correlated with reduced quality of care [4]. Deaths following RRT review remain high at 25 % [6] without improvement to end-of-life care [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
