‘It's not magic’: A qualitative analysis of geriatric physicians' explanations of cardio‐pulmonary resuscitation in hospital admissions
Aged, 80 and over
Medicine (General)
Physician-Patient Relations
Decision Making
geriatric patients
informed decision making
Cardiopulmonary Resuscitation
Hospitals
3. Good health
CPR; cardio-pulmonary resuscitation; code status; explanations; geriatric patients; informed decision making; medical decision making; patient-centred care; physician-patient communication; shared decision making
03 medical and health sciences
R5-920
0302 clinical medicine
cardio‐pulmonary resuscitation
explanations
Physicians
CPR
Humans
code status
Public aspects of medicine
RA1-1270
Original Research Papers
Aged
DOI:
10.1111/hex.13212
Publication Date:
2021-03-08T12:24:47Z
AUTHORS (4)
ABSTRACT
AbstractBackgroundDiscussing patient preferences for cardio‐pulmonary resuscitation (CPR) is routine in hospital admission for older people. The way the conversation is conducted plays an important role for patient comprehension and the ethics of decision making.ObjectiveThe objective was to examine how CPR is explained in geriatric rehabilitation hospital admission interviews, focussing on circumstances in which physicians explain CPR and the content of these explanations.MethodWe recorded forty‐three physician‐patient admission interviews taking place in a hospital in French‐speaking Switzerland, during which CPR was discussed. Data were analysed in French with thematic and conversation analysis, and the extracts used for publication were translated into English.ResultsMean patient age was 83.7 years; 53.5% were admitted for rehabilitation after surgery or traumatism. CPR was explained in 53.8% of the conversations. Most explanations were brief and concerned the technical procedures, mentioning only rarely potential outcome. With one exception, medical indication and prognosis of CPR did not feature in these explanations. Explanations occurred either before the patient's answer (as part of the question about CPR preferences) or after the patient's answer, generated by patients' indecision, misunderstanding and by the need to clarify answers.Discussion and conclusionsThe scarcity and simplicity of CPR explanations highlight a reluctance to have in‐depth discussions and reflect the assumption that CPR does not need explaining. Providing patients with accurate information about the outcomes and risks of CPR is incremental for reaching informed decisions and patient‐centred care.Patient contributionPatients were involved in the data collection stage of the study.
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