Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients

作者：Johnson, Claire E.^*; Chong, Jeffrey C.; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas

来源：Internal Medicine Journal, 2017, 47(7): 798-806.

DOI：10.1111/imj.13454

• do-not-resuscitate orders
• decision-making
• communication
• advance care planning
• medical futility

BackgroundAdvance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. @@@ AimTo assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. @@@ MethodsA pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. @@@ ResultsWhen compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). @@@ ConclusionAn increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.

• 出版日期2017-7