Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making

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.

Goals of patient care system change with video‐based education increases rates of advance cardiopulmonary resuscitation decision‐making and discussions in hospitalised rehabilitation patients

“…The workshop utilised locally developed videos during a draft phase 16 and (i) focused on clinical issues related to CPR decision-making, (ii) promoted the use of an ethical decision-making framework 12 and (iii) explored clinical communication using the video scenarios. The workshop utilised locally developed videos during a draft phase 16 and (i) focused on clinical issues related to CPR decision-making, (ii) promoted the use of an ethical decision-making framework 12 and (iii) explored clinical communication using the video scenarios.…”

“…The second part of the two-pronged strategy was a structured 2-h workshop for ward medical staff. The workshop utilised locally developed videos during a draft phase 16 and (i) focused on clinical issues related to CPR decision-making, (ii) promoted the use of an ethical decision-making framework 12 and (iii) explored clinical communication using the video scenarios. The content focused on patients with progressive, deteriorating illness.…”

“…Further development of the GoPC form and video material are described elsewhere. 16 The finalised training resources are available online at: http://ww2.health.wa. gov.au/Articles/A_E/Advance-CPR-decision-making-inthe-hospital-setting.…”

Advance care planning documentation strategies; goals‐of‐care as an alternative to not‐for‐resuscitation in medical and oncology patients. A pre–post controlled study on quantifiable outcomes

“…The second 6-month period (March-August 2017) was considered the intervention arm and investigated the implication of an inclusive four-treatment phase GOC form (Supporting Information Files S2, S3) adapted from previous local and interstate concepts. 2 The GOC arm of the study requested that treating consultants complete a GOC form for every patient admitted to the designated wards within 48 h of hospitalisation. While strongly encouraged through various educational means listed in Appendix S1, completion was not mandated.…”

A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings

“…19,24,25 Physician-related barriers include a lack of communication skills, 22 discomfort in discussing death and dying, 24 and fear of causing distress. 26 System-level barriers include time pressures, 21,26 lack of quality professional mentorship, 24,26 few guidelines on discussing EOL issues, 24 and lack of training around communicating about EOL. 21,24,26 These factors could explain why a recent Australian study found that only one-quarter of patients referred to the intensive care unit (ICU) had a documented GOC discussion.…”