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‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic

BACKGROUND: COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Comm...

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Autores principales: Tomkow, Louise, Dewhurst, Felicity, Hubmann, Michaela, Straub, Christina, Damisa, Efioanwan, Hanratty, Barbara, Todd, Chris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10308352/
https://www.ncbi.nlm.nih.gov/pubmed/37382203
http://dx.doi.org/10.1093/ageing/afad087
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author Tomkow, Louise
Dewhurst, Felicity
Hubmann, Michaela
Straub, Christina
Damisa, Efioanwan
Hanratty, Barbara
Todd, Chris
author_facet Tomkow, Louise
Dewhurst, Felicity
Hubmann, Michaela
Straub, Christina
Damisa, Efioanwan
Hanratty, Barbara
Todd, Chris
author_sort Tomkow, Louise
collection PubMed
description BACKGROUND: COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Commission. This paper explores the experiences of people who discussed DNACPR with a healthcare professional on behalf of a relative during the coronavirus pandemic, with the aim of identifying areas of good practice and what needs to be improved. METHODS: a total of 39 people participated in semi-structured interviews via video conferencing software or telephone. Data were evaluated using Framework Analysis. FINDINGS: results are presented around three main themes: understanding, communication and impact. Participants’ understanding about DNACPR was important, as those with better understanding tended to reflect more positively on their discussions with clinicians. The role of relatives in the decision-making process was a frequent source of misunderstanding. Healthcare professionals’ communication skills were important. Where discussions went well, relatives were given clear explanations and the opportunity to ask questions. However many relatives felt that conversations were rushed. DNACPR discussions can have a lasting impact—relatives reported them to be significant moments in care journeys. Many relatives perceived that they were asked to decide whether their relative should receive CPR and described enduring emotional consequences, including guilt. CONCLUSION: the pandemic has illuminated deficiencies in current practice around DNACPR discussion, which can have difficult to anticipate and lasting negative consequences for relatives. This research raises questions about the current approach to DNACPR decision-making.
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spelling pubmed-103083522023-06-30 ‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic Tomkow, Louise Dewhurst, Felicity Hubmann, Michaela Straub, Christina Damisa, Efioanwan Hanratty, Barbara Todd, Chris Age Ageing Qualitative Paper BACKGROUND: COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Commission. This paper explores the experiences of people who discussed DNACPR with a healthcare professional on behalf of a relative during the coronavirus pandemic, with the aim of identifying areas of good practice and what needs to be improved. METHODS: a total of 39 people participated in semi-structured interviews via video conferencing software or telephone. Data were evaluated using Framework Analysis. FINDINGS: results are presented around three main themes: understanding, communication and impact. Participants’ understanding about DNACPR was important, as those with better understanding tended to reflect more positively on their discussions with clinicians. The role of relatives in the decision-making process was a frequent source of misunderstanding. Healthcare professionals’ communication skills were important. Where discussions went well, relatives were given clear explanations and the opportunity to ask questions. However many relatives felt that conversations were rushed. DNACPR discussions can have a lasting impact—relatives reported them to be significant moments in care journeys. Many relatives perceived that they were asked to decide whether their relative should receive CPR and described enduring emotional consequences, including guilt. CONCLUSION: the pandemic has illuminated deficiencies in current practice around DNACPR discussion, which can have difficult to anticipate and lasting negative consequences for relatives. This research raises questions about the current approach to DNACPR decision-making. Oxford University Press 2023-06-05 /pmc/articles/PMC10308352/ /pubmed/37382203 http://dx.doi.org/10.1093/ageing/afad087 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Qualitative Paper
Tomkow, Louise
Dewhurst, Felicity
Hubmann, Michaela
Straub, Christina
Damisa, Efioanwan
Hanratty, Barbara
Todd, Chris
‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic
title ‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic
title_full ‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic
title_fullStr ‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic
title_full_unstemmed ‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic
title_short ‘That’s as hard a decision as you will ever have to make’: the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic
title_sort ‘that’s as hard a decision as you will ever have to make’: the experiences of people who discussed do not attempt cardiopulmonary resuscitation on behalf of a relative during the covid-19 pandemic
topic Qualitative Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10308352/
https://www.ncbi.nlm.nih.gov/pubmed/37382203
http://dx.doi.org/10.1093/ageing/afad087
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