The impact of language on the interpretation of resuscitation clinical care plans by doctors. A mixed methods study

Dignam, Colette; Thomas, Josephine; Brown, Margaret; Thompson, Campbell

doi:10.1371/journal.pone.0225338

Cited by 7 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously discussed, physicians report a lack of education and inexperience as barriers to effective resuscitation planning. Although some hospitals have used targeted short-term educational campaigns at the time a new resuscitation plan is introduced ( Dignam, Thomas, et al, 2019 ; Risk et al, 2019 ) available training opportunities are inadequate, with knowledge deficiencies evident in the few studies that have examined this ( Risk et al, 2019 ).…”

Section: Resuscitation Plans: the “New” No-cpr Ordermentioning

confidence: 99%

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Dignam

Brown

Thompson

2021

Gerontology and Geriatric Medicine

Self Cite

View full text Add to dashboard Cite

Not for Cardiopulmonary Resuscitation (No-CPR) orders, or the local equivalent, help prevent futile or unwanted cardiopulmonary resuscitation. The importance of unambiguous and readily available documentation at the time of arrest seems self-evident, as does the need to establish a patient’s treatment preferences prior to any clinical deterioration. Despite this, the frequency and quality of No-CPR orders remains highly variable, while discussions with the patient about their treatment preferences are undervalued, occur late in the disease process, or are overlooked entirely. This review explores the evolution of hospital patient No-CPR/Do Not Resuscitate decisions over the past 60 years. A process based on standardized resuscitation plans has been shown to increase the frequency and clarity of documentation, reduce stigma attached to the documentation of a No-CPR order, and support the delivery of medically appropriate and desired care for the hospital patient.

show abstract

Section: Resuscitation Plans: the “New” No-cpr Ordermentioning

confidence: 99%

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Dignam

Brown

Thompson

2021

Gerontology and Geriatric Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Inconsistencies in ACP documentation have also been observed within an Australian healthcare context. 38…”

Section: Comparison With Other Workmentioning

confidence: 99%

Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System

Standing

Patterson

Lee³

et al. 2020

BMJ Open

View full text Add to dashboard Cite

ObjectivesTo explore current challenges in interdisciplinary management of end-of-life care in the community and the potential of an Electronic Palliative Care Co-ordination System (EPaCCS) to facilitate the delivery of care that meets patient preferences.DesignQualitative study using interviews and focus groups.SettingHealth and Social Care Services in the North of England.Participants71 participants, 62 health and social care professionals, 9 patients and family members.ResultsFour key themes were identified: information sharing challenges; information sharing systems; perceived benefits of an EPaCCS and barriers to use and requirements for an EPaCCS. Challenges in sharing information were a source of frustration for health and social care professionals as well as patients, and were suggested to result in inappropriate hospital admissions. Current systems were perceived by participants to not work well—paper advance care planning (ACP) documentation was often unavailable or inaccessible, meaning it could not be used to inform decision-making at the point of care. Participants acknowledged the benefits of an EPaCCS to facilitate information sharing; however, they also raised concerns about confidentiality, and availability of the increased time and resources required to access and maintain such a system.ConclusionsEPaCCS offer a potential solution to information sharing challenges in end-of-life care. However, our findings suggest that there are issues in the initiation and documentation of end-of-life discussions that must be addressed through investment in training in order to ensure that there is sufficient information regarding ACP to populate the system. There is a need for further qualitative research evaluating use of an EPaCCS, which explores benefits and challenges, uptake and reasons for disparities in use to better understand the potential utility and implications of such systems.

show abstract

“…1,2 Even within individual states, each hospital may have its own unique do not resuscitate form and accompanying site-specific policies. 2,3 In New South Wales (NSW), a state-wide Adult Resuscitation Plan exists, and is governed by a NSW Health policy directive. 4 Resuscitation plans are expected to be completed if: the patient's recovery is uncertain; the treating clinician asks him or herself, 'Would I be surprised if this patient were to die in 6-12 months?'…”

Section: Introductionmentioning

confidence: 99%

Knowledge and confidence of junior medical doctors in discussing and documenting resuscitation plans: a cross‐sectional survey

Bryant

Waller

Pickles

et al. 2021

Internal Medicine Journal

View full text Add to dashboard Cite

Background: A resuscitation plan is a medically authorised order to use or withhold resuscitation interventions. Absence of appropriate resuscitation orders exposes patients to the risk of invasive medical interventions that may be of questionable benefit depending on individual circumstances.Aims: To describe among junior doctors: (i) self-reported confidence discussing and completing resuscitation plans; (ii) knowledge of resuscitation policy including whether resuscitation plans are legally enforceable and key triggers for completion; and (iii) the factors associated with higher knowledge of triggers for completing resuscitation plans.Methods: A cross-sectional survey was conducted at five hospitals. Junior doctors on clinical rotation were approached at scheduled training sessions, before or after ward rounds or at change of rotation orientation days and provided with a pen-and-paper survey.Results: A total of 118 junior doctors participated. Most felt confident discussing (79%; n = 92) and documenting (87%; n = 102) resuscitation plans with patients. However, only 45% (n = 52) of doctors correctly identified that resuscitation plans are legally enforceable medical orders. On average, doctors correctly identified 6.8 (standard deviation = 1.8) out of 10 triggers for completing a resuscitation plan. Doctors aged >30 years were four times more likely to have high knowledge of triggers for completing resuscitation plans (odds ratio 4.28 (95% confidence interval 1.54-11.89); P = 0.0053). Conclusion:Most junior doctors feel confident discussing and documenting resuscitation plans. There is a need to improve knowledge about legal obligations to follow completed resuscitation plans, and about when resuscitation plans should be completed to ensure they are completed with patients who are most at risk.

show abstract

The impact of language on the interpretation of resuscitation clinical care plans by doctors. A mixed methods study

Cited by 7 publications

References 13 publications

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System

Knowledge and confidence of junior medical doctors in discussing and documenting resuscitation plans: a cross‐sectional survey

Contact Info

Product

Resources

About