Development of an Explanatory Model of Resuscitation Preference Decision Making

Area of Science:

• Medical Ethics
• Patient Care
• Decision Making

Background:

• Establishing resuscitation preferences before emergencies ensures patient wishes guide care.
• However, these conversations are challenging, and influences on choices remain unclear.

Purpose of the Study:

• To identify influences on patient resuscitation preferences.
• To understand the relationships between these influences.
• To develop an explanatory model for resuscitation preference decisions.

Main Methods:

• Constructivist grounded theory analyzed 107 clinical notes from resuscitation preference conversations.
• Purposeful sampling with maximum variation was employed.
• Iterative data collection, analysis, and constant comparison enhanced rigor.

Main Results:

• A resuscitation preferences conversation model was developed with 27 coding categories.
• Patient and Substitute Decision Maker (SDM) preferences were informed by 'Ability to Engage in Meaningful Activity,' 'Trajectory,' and 'Perceptions and Beliefs.'
• SDM choices were further informed by 'Social and Knowing' and 'Experiences.'

Conclusions:

• The developed model explains relationships between influences and preferences, building on prior work.
• Integrating patient and SDM perspectives highlights the SDM's complex role.
• The model can enhance existing guides for effective resuscitation preference discussions.