1. ‘It's not magic’: A qualitative analysis of geriatric physicians' explanations of cardio‐pulmonary resuscitation in hospital admissions
- Author
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Eve Rubli Truchard, Ralf J. Jox, Anca-Cristina Sterie, and Laura Jones
- Subjects
Medicine (General) ,medicine.medical_treatment ,CPR ,cardio-pulmonary resuscitation ,code status ,explanations ,geriatric patients ,informed decision making ,medical decision making ,patient-centred care ,physician-patient communication ,shared decision making ,0302 clinical medicine ,cardio‐pulmonary resuscitation ,030212 general & internal medicine ,health care economics and organizations ,media_common ,Aged, 80 and over ,Rehabilitation ,Magic (illusion) ,030503 health policy & services ,Hospitals ,Original Research Paper ,Conversation analysis ,Cardio-pulmonary resuscitation ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,medicine.medical_specialty ,Geriatric rehabilitation ,media_common.quotation_subject ,Decision Making ,education ,03 medical and health sciences ,R5-920 ,Qualitative analysis ,Physicians ,medicine ,Humans ,Conversation ,cardiovascular diseases ,physician‐patient communication ,patient‐centred care ,Aged ,Physician-Patient Relations ,Data collection ,business.industry ,Public Health, Environmental and Occupational Health ,Cardiopulmonary Resuscitation ,Family medicine ,business ,Original Research Papers - Abstract
Background Discussing 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. Objective The 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. Method We 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. Results Mean 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 conclusions The 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 contribution Patients were involved in the data collection stage of the study.
- Published
- 2021