PubMed · 11655072
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Patrick Miller. 1997. Struggle.. https://pubmed.ncbi.nlm.nih.gov/11655072/
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Nowadays, cardiopulmonary resuscitation is not routinely discussed with all hospital patients, even though it should be for a number of reasons. First of all, every patient may suffer cardiac arrest, and the overall outcome of a subsequent attempt at resuscitation is difficult to predict. Besides, patients who do not wish to be resuscitated often do not tell that to the physician of their own accord. Patients should therefore be more actively informed and encouraged to express their own preferences. The routine discussion of possible resuscitation gives physicians the opportunity to discuss, determine and delimit the extent of the intended medical procedure. In the literature, communication problems in three different areas can be identified as a cause of the present situation. These are--for both physician and patient--inability, lack of insight and unwillingness to discuss resuscitation. Physicians should be aware of the identified communication problems and deal with them in a professional manner. An understanding of these problems forms the basis for a broader implementation of resuscitation discussions in hospitals.
BACKGROUND: A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes. METHODS: Ambulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented. RESULTS: Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size [ES] = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively. CONCLUSION: A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.
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