Abstract
BackgroundDiscussing patient preferences for cardio‐pulmonary resuscitation (CPR) is routine in hospital admission for older people. The way the conversation is conducted plays an important role for patient comprehension and the ethics of decision making.ObjectiveThe objective was to examine how CPR is explained in geriatric rehabilitation hospital admission interviews, focussing on circumstances in which physicians explain CPR and the content of these explanations.MethodWe recorded forty‐three physician‐patient admission interviews taking place in a hospital in French‐speaking Switzerland, during which CPR was discussed. Data were analysed in French with thematic and conversation analysis, and the extracts used for publication were translated into English.ResultsMean patient age was 83.7 years; 53.5% were admitted for rehabilitation after surgery or traumatism. CPR was explained in 53.8% of the conversations. Most explanations were brief and concerned the technical procedures, mentioning only rarely potential outcome. With one exception, medical indication and prognosis of CPR did not feature in these explanations. Explanations occurred either before the patient's answer (as part of the question about CPR preferences) or after the patient's answer, generated by patients' indecision, misunderstanding and by the need to clarify answers.Discussion and conclusionsThe scarcity and simplicity of CPR explanations highlight a reluctance to have in‐depth discussions and reflect the assumption that CPR does not need explaining. Providing patients with accurate information about the outcomes and risks of CPR is incremental for reaching informed decisions and patient‐centred care.Patient contributionPatients were involved in the data collection stage of the study.
Highlights
Physicians play a crucial role in informing patients about treatment options and in obtaining informed consent for treatment decision making; this is all the more important when it comes to life-prolonging interventions such as cardio-pulmonary resuscitation (CPR), which is regularly discussed in anticipation on hospital admission
With a high risk of adverse outcomes, CPR is of little value to geriatric patients suffering from multiple morbidities.[29]
A discussion about CPR would help patients become more knowledgeable about their medical trajectory and gain information that would allow them to understand why CPR is not medically beneficial for them, while being reassured that everything will be done to maintain their quality of life and death
Summary
Physicians play a crucial role in informing patients about treatment options and in obtaining informed consent for treatment decision making; this is all the more important when it comes to life-prolonging interventions such as cardio-pulmonary resuscitation (CPR), which is regularly discussed in anticipation on hospital admission. While CPR for older hospitalized patients generally results are rather poor,[1] many patients hold erroneous beliefs overestimating the survival chances and underestimating the risk of adverse outcomes, beliefs that underpin their wishes to undergo this procedure.[2,3] Choices in favour of CPR may reflect the patients' impression that forgoing CPR is equivalent to choosing death over life.[4]. Discussing patient preferences for cardio-pulmonary resuscitation (CPR) is routine in hospital admission for older people. Objective: The objective was to examine how CPR is explained in geriatric rehabilitation hospital admission interviews, focussing on circumstances in which physicians explain CPR and the content of these explanations. Patient contribution: Patients were involved in the data collection stage of the study
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