Seriously ill hospitalized patients’ perspectives on the benefits and harms of two models of hospital CPR discussions

Abstract

Objective To describe seriously ill patients’ perspectives on expert-endorsed approaches for hospital cardiopulmonary resuscitation (CPR) discussions. Methods We created two videos depicting a hospital doctor discussing CPR with a seriously ill patient. One depicted a values-based approach with a doctor's recommendation, and one an information-focused approach without a recommendation. During semi-structured interviews, 20 seriously ill hospitalized patients viewed and commented on both videos. We conducted a thematic analysis to describe benefits and harms of specific discussion components. Results Half of participants reported no preference between the videos; 35% preferred the information-focused, and 15% the values-based. Participants’ reactions to the discussion components varied. They identified both benefits and harms with components in both videos,though most felt comfortable with all components (range, 60-65%) except for the doctor's recommendation in the values-based video. Only 40% would feel comfortable receiving a recommendation, while 65% would feel comfortable with the doctor eliciting their CPR preference as in the information-focused video, p=0.03. Conclusion Participants’ reactions to expert-endorsed discussion components varied. Most would feel uncomfortable receiving a doctor's recommendation about CPR. Practice Implications Participants’ varied reactions suggest the need to tailor CPR discussions to individual patients. Many patients may find doctor's recommendations to be problematic.

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