Cardiopulmonary Resuscitation—From the Patient'S Perspective

Abstract

With increasing emphasis on patient autonomy, patients are encouraged to be more involved in end-of-life issues, including the use of extraordinary efforts to prolong their lives. Being able to make anticipatory decisions is seen to promote autonomy, empower patients and optimise patient care. To facilitate shared decision-making, patients need to have a clear and accurate understanding of cardiopulmonary resuscitation (CPR). This study aims to understand the knowledge and perspectives of the local community regarding resuscitation options and end-of-life decision-making and to explore ways to improve the quality of end-of-life discussions. An interviewer-administered survey was conducted with a prospectively recruited group of surgical patients admitted postoperatively to the day surgery ward of a single tertiary institution in Singapore from April to May 2015. The survey, modelled after two validated questionnaires, measured patients' knowledge, attitudes and preferences regarding CPR in a series of 18 questions. Fifty-one out of 67 (76.1%) patients completed the survey. Results indicated that 80.4% (n=41) of participants correctly understood the purpose of CPR, but 64.7% (n=33) did not know of any possible complications of CPR. Less than half (n=21, 41.2%) of participants had thought about life support measures they wanted for themselves. Most of the participants agreed that they should personally be involved in making end-of-life decisions (n=44, 86.3%). Many patients had a poor knowledge of CPR and other resuscitation measures and the majority overestimated the success rate of CPR. However, a majority were receptive to improving their knowledge and keen to discuss end-of-life issues with physicians.

Usage of do-not-attempt-to-resuscitate orders in a Swedish community hospital – patient involvement, documentation and compliance

“…However, even if this might in some cases be ethically acceptable, it is not according to the law and might need to unnecessary treatment and confusion of health care personnel not aware of these undocumented decisions. Obviously, even if the discussion and information is documented, little is known about patients´ understanding of the implications of CPR [ 26 ].…”

A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

“…According to several studies, patients with terminal illnesses want to be involved in the decision of DNACPR and the care planning [13, 14]. Moreover, it has been shown that there is often a miss-match between the patient’s preferences for CPR and the physician’s perceptions about the wish of the patient [15].…”

“…Many patients have a poor knowledge of CPR and the majority overestimate the success rate of CPR [14, 24]. Notably, physicians also often overestimate the success rate of CPR [24].…”

“…The results presented here show that education of the physicians about poor outcome of CPR and written guidelines about decision making was not enough for more DNACPR-decisions to be taken. Previous studies show the importance of education of the patients about the outcome of CPR [13, 14, 23]. Thus, in future studies a prospective design should be employed with an intervention including different educational approaches for patients about CPR.…”

Patients’ attitude and knowledge towards resuscitation and advance care planning at the palliative care unit

“…Furthermore, in the case of rejection of resuscitation by a patient, this decision must be respected and documented. However, many patients lack knowledge of resuscitation (Wee, Chang, Lau, Wong, & Ong, 2017 ). The handling of resuscitation policies also varies within different countries and institutions.…”