Talk CPR - a technology project to improve communication in do not attempt cardiopulmonary resuscitation decisions in palliative illness

Abstract

BackgroundA national Do Not Attempt Cardiopulmonary Resuscitation policy was rolled out for the National Health Service in Wales in 2015. A national steering group led on producing information videos and a website for patients, carers and healthcare professionals, forming part of a quality improvement program. Videos were planned, scripted and produced with healthcare professionals and patient/carer representatives, and were completed with both English and Welsh language versions. The TalkCPR videos encourage and promote open discussion about Cardiopulmonary Resuscitation (CPR) and DNACPR in palliative care situations.MethodsWe worked with patient/carer groups to evaluate whether video resources to convey the salient facts involved in CPR and DNACPR decisions for people with palliative and life-limiting illness were acceptable or not. We conducted a mixed-method design service review in five phases to evaluate whether this technological resource could help. After creating video and website materials, they were evaluated by doctors, nurses and a patient/carer group. We also sent out one lightweight TalkCPR video media pad to each practice in Wales. These rechargeable electronic video media pads had communication videos pre-loaded for easy viewing, especially in areas with poor roaming data coverage.ResultsVideos were demonstrably acceptable to both patient and carer groups, and improved healthcare professional confidence and understanding. Videos went live on the TalkCPR website, in all Welsh Health Boards and on Youtube, and are now used in routine practice throughout Wales.ConclusionThis is the first time that DNACPR information videos are aimed directly at palliative care patients and carers, to explore this sensitive subject with them, and to encourage them to approach their doctor or nurse about it. The website, app and video media pads were developed by patients, the Digital Legacy Association, Welsh NHS IT services, Welsh Government, the Bevan Commission and the Dying Matters Charity in Wales ‘Byw Nawr’. The GMC, the Royal College of General Practitioners and NICE have listed TalkCPR as a learning resource. There has also been a collaboration with Falmouth University Art College, who helped produce graphic designs to facilitate and encourage discussions about CPR and end of life care.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0370-9) contains supplementary material, which is available to authorized users.

End-of-life care preferences of the general public and recommendations of healthcare providers: a nationwide survey in Japan

“…Therefore, the general public might overestimate the success rate of CPR and the benefit of parenteral nutrition and hydration in late-stage cancer patients. A recent study found that specific information videos and websites regarding LST for the general public, such as the Talk CPR project, which provides knowledge regarding CPR [29], are helpful to reduce the dissonance between the general public and healthcare providers. Such information provision may also encourage patients and caregivers to approach their healthcare provider about this issue.…”

“…Thus, healthcare providers should address the expectations of patients with advanced cancer about aggressive treatment, LST, and limited medical care to initiate and facilitate EOL discussion. A recent study suggested that providing specific information through different modalities can improve the confidence and understanding of healthcare providers regarding EOL discussion, and adding such information to existing education programs is considered effective [29].…”

A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

“…In Wales, UK, a new approach to tackle the sensitive issue of DNACPR discussions was developed in 2015 called “TalkCPR” [23]. This educational program included websites, videos and media pads aimed at both patients and healthcare professionals [23].…”

“…In Wales, UK, a new approach to tackle the sensitive issue of DNACPR discussions was developed in 2015 called “TalkCPR” [23]. This educational program included websites, videos and media pads aimed at both patients and healthcare professionals [23]. This approach was very successful, and physicians exposed to the education reported that they discussed DNACPR more frequently with their patients and felt more comfortable with the discussion.…”

“…The results presented here show that education of the physicians about poor outcome of CPR and written guidelines about decision making was not enough for more DNACPR-decisions to be taken. Previous studies show the importance of education of the patients about the outcome of CPR [13, 14, 23]. Thus, in future studies a prospective design should be employed with an intervention including different educational approaches for patients about CPR.…”