Discussing resuscitation preferences with patients: Challenges and rewards

Chittenden, Eva; Clark, Susannah; Pantilat, Steven Z.

doi:10.1002/jhm.110

Cited by 33 publications

(24 citation statements)

References 70 publications

(49 reference statements)

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“…First, residents were divided into groups of six or seven learners and taught key components of a CSD as described in the literature and by expert consensus. [15][16][17] Two hospice and palliative medicine faculty members (KN and ES) were preceptors. Seminars lasted 2 hours and content included: 1) defining advance care planning, 2) understanding the indications for a CSD, 3) reviewing a framework for these discussions, and 4) exploring strategies for responding to patient emotions.…”

Section: Methodsmentioning

confidence: 99%

“…20 The checklist was created by a panel of three hospice and palliative medicine physicians and four communication skills experts, based on previous work, 6,13 and expert recommendation regarding essential elements of patient-centered CSD communication. 7,[15][16][17] The checklist had three sections: 1) patient-centered interviewing skills, 2) CSD skills, and 3) responding to emotion. Each checklist item was scored dichotomously (i.e., done correctly or done incorrectly), assigned one point when performed correctly, and given equal weight.…”

Section: Outcomes and Measurementsmentioning

confidence: 99%

See 1 more Smart Citation

Improving Residents' Code Status Discussion Skills: A Randomized Trial

Szmuilowicz

Neely

Sharma

et al. 2012

Journal of Palliative Medicine

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Background: Inpatient Code Status Discussions (CSDs) are commonly facilitated by resident physicians, despite inadequate training. We studied the efficacy of a CSD communication skills training intervention for internal medicine residents. Methods: This was a prospective, randomized controlled trial of a multimodality communication skills educational intervention for postgraduate year (PGY) 1 residents. Intervention group residents completed a 2 hour teaching session with deliberate practice of communication skills, online modules, self-reflection, and a booster training session in addition to assigned clinical rotations. Control group residents completed clinical rotations alone. CSD skills of residents in both groups were assessed 2 months after the intervention using an 18 item behavioral checklist during a standardized patient encounter. Average scores for intervention and control group residents were calculated and between-group differences on the CSD skills assessment were evaluated using two-tailed independent sample t tests. Results: Intervention group residents displayed higher overall scores on the simulated CSD (75.1% versus 53.2%, p < 0.0001) than control group residents. The intervention group also displayed a greater number of key CSD communication behaviors and facilitated significantly longer conversations. The training, evaluation, and feedback sessions were rated highly. Conclusion: A focused, multimodality curriculum can improve resident performance of simulated CSDs. Skill improvement lasted for at least 2 months after the intervention. Further studies are needed to assess skill retention and to set minimum performance standards.

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Section: Methodsmentioning

confidence: 99%

Section: Outcomes and Measurementsmentioning

confidence: 99%

Improving Residents' Code Status Discussion Skills: A Randomized Trial

Szmuilowicz

Neely

Sharma

et al. 2012

Journal of Palliative Medicine

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“…It is best to frame these difficult discussions in the context of established goals and values of the child and family [64]. Inquiring about the perceived health status of the child is a useful way to introduce the discussion.…”

Section: Advance Care Planningmentioning

confidence: 99%

Living Life to the Fullest: Early Integration of Palliative Care into the Lives of Children with Chronic Complex Conditions

Rapoport

Beaune²,

Weingarten³

et al. 2012

CPR

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Increasing numbers of children living with chronic complex conditions also means an increase in the number of children with a potentially life-threatening illness. While curative and life-prolonging therapies continue to stretch the boundaries of what is possible, pediatric mortality remains highest among this group of children. In light of their medical fragility and unpredictable trajectories, children with chronic complex conditions are ideal candidates for palliative care. Integration of palliative care concurrently with curative or life-prolonging therapies results in improved outcomes and is widely endorsed as the most appropriate model of care for this population of children. This paper dispels common misconceptions about pediatric palliative care and outlines the benefits realized by children living with chronic complex conditions, and their families, when palliative care is introduced early in the course of their illness. Practical suggestions to facilitate difficult conversations and to manage challenging clinical situations are provided.

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“…The care of seriously ill patients and those approaching the end of life can be challenging and richly rewarding [17]. Working with Mrs Morton and her family to help ease her respiratory distress; pausing the resuscitation long enough to understand her preferences for care; providing support, compassion, and empathy to her family; and implementing a plan consistent with her wishes allow the clinicians to use their heart as well as their head to provide the best possible care to patients and their families.…”

Section: Rewarding Practicementioning

confidence: 99%

Hospital Care for Seriously Ill Patients and Their Families

Pantilat¹,

Anderson²,

Gonzales³

et al. 2015

Hospital‐Based Palliative Medicine

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Mrs Morton was an 82-year-old woman with ovarian cancer metastatic to the lung, liver, and peritoneum with massive ascites diagnosed 1 year ago. She had undergone many cycles of chemotherapy but stopped chemo several months ago due to progression of disease and increasing fatigue. Mrs Morton was living at home with her daughter, son-in-law, and three grandchildren. A few days earlier, she had stopped eating and drinking. She became sleepier and spent all of her time in bed. On the morning of admission, Mrs Morton's daughter awoke to find that her mother was not able to speak or even open her eyes and was moaning and breathing fast. Feeling panicked, her daughter called 911. The ambulance arrived within a few minutes. They found Mrs Morton hypotensive, tachypneic, tachycardic, hypoxic, and in respiratory distress. They asked about advance directives, but were told that Mrs Morton had not completed one. They started an IV, gave fluids, administered oxygen, and rushed Mrs Morton to the hospital.On arrival in the emergency department, the emergency physician and nurse asked the family, "Would you like us to do everything possible?" Her family responded, "Yes," as virtually anyone would to this question. The emergency physician called the hospitalist on call STAT to the emergency department to admit Mrs Morton and notified the intensive care unit that she would soon be on her way up.

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Discussing resuscitation preferences with patients: Challenges and rewards

Cited by 33 publications

References 70 publications

Improving Residents' Code Status Discussion Skills: A Randomized Trial

Improving Residents' Code Status Discussion Skills: A Randomized Trial

Living Life to the Fullest: Early Integration of Palliative Care into the Lives of Children with Chronic Complex Conditions

Hospital Care for Seriously Ill Patients and Their Families

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