Patients’ attitude and knowledge towards resuscitation and advance care planning at the palliative care unit

Abstract

Objective There is a lack of information about patients’ attitudes towards and knowledge of resuscitation and advance care planning (ACP) in the palliative care unit (PCU). The aims of this study were to examine (a) patients’ attitudes towards and knowledge of the topic of resuscitation, (b) patients’ level of education about their illness and (c) their concept of ACP. Methods This study used a qualitative methodology that involved semi‐structured interviews with advanced cancer patients admitted to the PCU. Interviews were conducted during the first week after admission, recorded digitally and transcribed verbatim. Data were analysed through content analysis using NVivo 12. Results Eighteen interviews revealed the following themes: (a) ambivalence regarding preference for or refusal of resuscitation, (b) patient confidence concerning their level of education, (c) lack of information about ACP and (d) positive perception of the stay in the PCU. The data showed that a high percentage of PCU patients desired resuscitation even though education about their illness was mostly perceived as good. Many patients did not receive information about ACP. Patients perceived the stay in the PCU positively. Conclusion The study results reveal that there is lack of knowledge about ACP and resuscitation in patients in the PCU.

Attitudes toward End-of-Life Resuscitation: A Psychometric Evaluation of a Novel Attitude Scale

“…However, only 9.4% of our study samples had signed a DNR order (Table 1). Previous studies demonstrated that medical condition is one of the most important factors affecting the signature of a DNR order [7,8,13,17]. The low percentage can be explained by the reason that our study sample came from general medical and surgical inpatients who are not at immediate risk of death.…”

“…The results are congruent with previous studies, in which people considered that discussions about DNR orders were stressful, being worried about the possible undertreatment, neglect, or even abuse from the process of treatment [8,11,12]. Sometimes, in order to relieve the distress and uneasiness, this stress would be modulated by defense mechanisms (e.g., inappropriate thinking or behavior, thinking that it is too early or unnecessary to make an end-of-life decision, or belief that it is others' responsibility) [7,8,13,14,17]. In addition, after putting all three factors into a logistical regression with the enter method, the factor of 'stress, avoidance, and ignorance' was the only independent predictor of participating in the discussion regarding end-of-life CPR/DNR orders (Table 4).…”

“…Indeed, empirical evidence showed that patients hospitalized with acute heart failure and with DNR orders were significantly less likely to have received any quality treatment than those without DNR orders [12]. Other people might not want to talk about end-of-life DNR orders because they consider it unnecessary, or too early, even in terminal cancer patients [7,13]. Instead, they prefer to designate a family member to act as a surrogate decision-maker [14], which is particularly prevalent in Asian societies.…”

Analysis of Medical Directive Information from Bay Area Medical Providers

“…This plan includes various recommendation to analyze policy assessment on care directives and improve ACP for PLWD (WHO, 2018). Part of this improvement effort with ACP includes education efforts to help caregivers and PLWD understand the disease and caregiving journey and the encouragement to ask the right questions during ACP for the discussion of the detailed aspects of future care treatment and medical interventions (Sellars et al, 2019;Unself et al, 2019;and Ashton et al, 2016). The importance of education indicates an aspect of caregiving since they are faced with the possibility of learning new skills to care for their loved one, from learning how to do safe transfers to nurse-trained skills like foley-catheter changes and simple, preventative wound care.…”