CPR decision-making conversations in the UK: an integrative review

Area of Science:

• Medical Ethics
• Patient Experience
• Healthcare Communication

Background:

• Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) discussions are ethically and legally complex.
• Existing guidelines lack patient, family, and caregiver perspectives.
• This review synthesizes experiences of advance cardiopulmonary resuscitation (CPR) decision-making discussions.

Purpose of the Study:

• To explore patient, family, and caregiver experiences with DNACPR discussions.
• To identify best practices for approaching these sensitive conversations from the patient's viewpoint.
• To inform future guidelines and clinical practice regarding DNACPR decision-making.

Main Methods:

• Integrative review of UK literature (2000-2016).
• Inclusion of qualitative and quantitative studies.
• Analysis of 20 UK papers from 773 identified abstracts.

Main Results:

• Patients and families prefer discussions initiated by trusted individuals.
• Family involvement preferences vary contextually; earlier discussions are often preferred.
• Acute care settings are suboptimal for these conversations; they should be part of wider future care planning.
• Effective communication skills training is crucial for healthcare professionals.

Conclusions:

• Patient narratives regarding DNACPR discussions are often at odds with current statutory frameworks.
• Healthcare professionals face challenges balancing service pressures with patient-centered care.
• Prioritizing patient and family experiences is essential for minimizing harm and advancing realistic medicine.