P-95 Thinking ahead: discussing resuscitation decisions with diverse communities

Abstract

Background Improving Advance Care Planning (ACP) and increasing its equitable access is a key UK government strategy. Evidence (mainly from the USA) suggests that there are lower levels of ACP in people from Black, Asian and Minority Ethnic (BAME) communities. People from some BAME groups also seem to be more likely to desire invasive medical interventions, regardless of prognosis and impact on quality of life. The beliefs, values and needs of BAME communities in the UK have not been explored to see if the UK model of decision making around resuscitation ‘fits’ for them. Also, healthcare professionals (HCPs) report that they do not feel confident in providing culturally appropriate care for BAME patients and families in this situation. Aims To identify barriers and enablers to HCPs discussing deterioration and resuscitation with patients and families from BAME communities, and to identify associated HCP training needs. Methods Qualitative semi structured interviews with 30 HCPs. Results HCPs’ interviews identify key barriers and facilitators of resuscitation discussions including differing attitudes towards death; differing values amongst different generations of migrants; and the need to find a balance between the desire to act in a non-discriminatory way whilst respecting cultural differences. Analysis of interviews informed a set of statements regarding decision making about resuscitation, which are being used as part of a ranking exercise (using Q methodology) with members of the public. Conclusion There are significant barriers for HCPs when discussing resuscitation decisions with people from BAME communities. This increases the complexity of navigating ACP and achieving patients‘ preferences.