Trust and Distrust in CPR Decisions

Abstract

Trust is essential in human relationships including those within healthcare. Recent studies have raised concerns about patients' declining levels of trust. This article will explore the role of trust in decisionmaking about cardiopulmonary resuscitation (CPR). In this research thirty-three senior doctors, junior doctors and division 1 nurses were interviewed about how decisions are made about providing CPR. Analysis of these interviews identified lack of trust as one cause for poor understanding of treatment decisions and lack of acceptance of medical judgement. Two key implications emerged from the analysis. First, before embarking on a discussion about CPR it is essential to establish trust between the doctor and the patient/family. Secondly, it is essential that the CPR discussion itself does not undermine trust and cause harm to the patient.

Trust and distrust between patient and doctor

“…In one (unspecified) country, it was reportedly essential to continue visibly attempting CPR until the patient's family arrived to witness the attempts, even when the patient had already died. Hayes remarks, ‘Discussions by Australian doctors about withholding non‐beneficial CPR may well be looked upon with suspicion and distrust if this is not the patient's experience or expectation of how things are done in their country of origin’ ([8], p. 18).…”

“…Barbara Hayes investigates the importance of trust in decision making about cardiopulmonary resuscitation (CPR), drawing on interviews with 33 doctors and nurses in Australia [8]. Interviewees talked about their experiences of discussing CPR with patients and their families in order to make an advance decision about how to proceed.…”

“…Hayes stresses the importance of developing trust beforehand: 'Recognising the importance of trust makes evident the need to establish a level of trust before embarking on a discussion about withholding CPR. This is necessary in order to minimise the potential harm that may arise from this discussion' ( [8], p. 120). Many nurses reported that they were more trusted than doctors, and this may be connected to their greater opportunity to become familiar with patients and families before the difficult conversation must take place; both doctors and nurses emphasized the value of taking time over these conversations and the challenge of finding enough time.…”

The Goals of Patient Care project: implementing a proactive approach to patient‐centred decision‐making

“…Most Australian jurisdictions do not require specific consent to ‘not treat’, although best practice warrants open communication of these decisions . Poor communication of decisions to limit treatment may compromise the trust inherent in the doctor–patient relationship …”

“…2 Poor communication of decisions to limit treatment may compromise the trust inherent in the doctor-patient relationship. 22 Avoiding proactive decisions, and potentially confronting discussions, about treatment goals risks leaving these important matters unaddressed until the event of a medical emergency. Rapid decision-making may be required before consideration of the whole patient, and their goals, can be fully undertaken.…”