Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations

2017 ◽  
Vol 26 (1) ◽  
pp. 84-95 ◽  
Author(s):  
Pamela Bjorklund ◽  
Denise M Lund
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Hospital Setting ◽  
Ethical Considerations ◽  
Communicative Skills ◽  
Code Status ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Patients often are confronted with the choice to allow cardiopulmonary resuscitation (CPR) should cardiac arrest occur. Typically, informed consent for CPR does not also include detailed discussion about survival rates, possible consequences of survival, and/or potential impacts on functionality post-CPR. Objective: A lack of communication about these issues between providers and patients/families complicates CPR decision-making and highlights the ethical imperative of practice changes that educate patients and families in those deeper and more detailed ways. Design: This review integrates disparate literature on the aftermath of CPR and the ethics implications of CPR decision-making as it relates to and is affected by informed consent and subsequent choices for code status by seriously ill patients and their surrogates/proxies within the hospital setting. Margaret Urban Walker’s moral philosophy provides a framework to view informed consent as a practice of responsibility. Ethical considerations: Given nurses’ communicative skills, ethos of care and advocacy, and expertise in therapeutic relationships, communication around DNAR decision-making might look quite different if institutional norms in education, healthcare, law, and public policy held nurses overtly responsible for informed consent in some greater measure. Findings: Analysis from this perspective shows where changes in informed consent practices are needed and where leverage might be exerted to create change in the direction of deeper and more detailed discussions about CPR survival rates and possible consequences of survival.

scholarly journals Patient–physician conversations about life-sustaining treatment: Treatment preferences and participant assessments

2021 ◽  
pp. 1-7
Author(s):  
Lone Doris Tuesen ◽  
Hans-Henrik Bülow ◽  
Anne Sophie Ågård ◽  
Sverre Maintz Strøm ◽  
Erik Fromme ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiopulmonary Resuscitation ◽  
Nursing Home Residents ◽  
Treatment Preferences ◽  
Comfort Care ◽  
Life Sustaining Treatment ◽  
Seriously Ill Patients ◽  
High Degree ◽  
Seriously Ill ◽  
Very High

Abstract Objective In 2019, the Danish parliament issued legislation requiring Danish physicians to clarify and honor seriously ill patients’ treatment preferences. The American POLST (Physician Orders for Life-Sustaining Treatment) document could be a valuable model for this process. The aim of the study was to examine patients' preferences for life-sustaining treatment and participant assessment of a Danish POLST form. Methods The study is a prospective intervention based on a pilot-tested Danish POLST form. Participant assessments were examined using questionnaire surveys. Patients with serious illness and/or frailty from seven hospital wards, two general practitioners, and four nursing homes were included. The patients and their physicians completed the POLST form based on a process of shared decision-making. Results A total of 95 patients (aged 41–95) participated. Hereof, 88% declined cardiopulmonary resuscitation, 83% preferred limited medical interventions or comfort care, and 74% did not require artificial nutrition. The preferences were similar within age groups, genders, and locations, but with a tendency toward younger patients being more in favor of full treatment and nursing home residents being more in favor of cardiopulmonary resuscitation. Questionnaire response rates were 69% (66/95) for patients, 79% (22/28) for physicians, and 31% (9/29) for nurses. Hereof, the majority of patients, physicians, and nurses found that the POLST form was usable for conversations and decision-making about life-sustaining treatment to either a high or very high degree. Significance of results The majority of seriously ill patients did not want a resuscitation attempt and opted for selected treatments. The majority of participants found that the Danish POLST was usable for conversations and decisions about life-sustaining treatment to either a high or a very high degree, and that the POLST form facilitated an opportunity to openly discuss life-sustaining treatment.

Choices of seriously ill patients about cardiopulmonary resuscitation: Correlates and outcomes

Resuscitation ◽  
1996 ◽  
Vol 33 (1) ◽  
pp. 87 ◽  
Author(s):  
RS Phillips ◽  
NS Wenger ◽  
J Teno ◽  
RK Oye ◽  
S Youngner ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Seriously Ill Patients ◽  
Seriously Ill

Can You Go Change the Family’s Mind?

2020 ◽  
pp. 27-34
Author(s):  
Toluwalase Ajayi
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Negative Emotions ◽  
Course Of Disease ◽  
Code Status ◽  
Legal Guardians ◽  
The Common ◽  
Seriously Ill

Parents and legal guardians of seriously ill children are often faced with challenging decisions regarding code status and cardiopulmonary resuscitation. There is commonly a certain amount of discomfort and negative emotions surrounding these conversations. Unfortunately, because of this, when clinicians do initiate these conversations, it is often too late in the course of disease, and opportunities for the children and their families to have their preferred end-of-life wishes may be missed. This chapter reviews the common myths and misconceptions surrounding the code status conversation by addressing the emotions associated with it. In addition, the chapter provides a step-by-step guideline on how to approach this topic.

“There were more decisions and more options than just yes or no”: Evaluating a decision aid for advanced cancer patients and their family caregivers

2016 ◽  
Vol 15 (1) ◽  
pp. 44-56 ◽  
Author(s):  
Marie Bakitas ◽  
J. Nicholas Dionne-Odom ◽  
Lisa Jackson ◽  
Jennifer Frost ◽  
Margaret F. Bishop ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advance Care Planning ◽  
Decision Aid ◽  
Care Planning ◽  
Serious Illness ◽  
Early Palliative Care ◽  
Advance Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

AbstractObjective:Few decision aids are available for patients with a serious illness who face many treatment and end-of-life decisions. We evaluated the Looking Ahead: Choices for Medical Care When You're Seriously Ill® patient decision aid (PtDA), one component of an early palliative care clinical trial.Method:Our participants included individuals with advanced cancer and their caregivers who had participated in the ENABLE (Educate, Nurture, Advise, Before Life Ends) early palliative care telehealth randomized controlled trial (RCT) conducted in a National Cancer Institute-designated cancer center, a U.S. Department of Veterans Affairs medical center, and affiliated outreach clinics in rural New England. ENABLE included six weekly patient and three weekly family caregiver structured sessions. Participants watched the Looking Ahead PtDA prior to session 3, which covered content on decision making and advance care planning. Nurse coaches employed semistructured interviews to obtain feedback from consecutive patient and caregiver participants approximately one week after viewing the Looking Ahead PtDA program (booklet and DVD).Results:Between April 1, 2011, and October 31, 2012, 57 patients (mean age = 64), 42% of whom had lung and 23% gastrointestinal cancer, and 20 caregivers (mean age = 59), 80% of whom were spouses, completed the PtDA evaluation. Participants reported a high degree of satisfaction with the PtDA format, as well as with its length and clarity. They found the format of using patient interviews “validating.” The key themes were: (1) “the earlier the better” to view the PtDA; (2) feeling empowered, aware of different options, and an urgency to participate in advance care planning.Significance of results:The Looking Ahead PtDA was well received and helped patients with a serious illness realize the importance of prospective decision making in guiding their treatment pathways. We found that this PtDA can help seriously ill patients prior to the end of life to understand and discuss future healthcare decision making. However, systems to routinely provide PtDAs to seriously ill patients are yet not well developed.

Beyond the Do-not-resuscitate Order: An Expanded Approach to Decision-making Regarding Cardiopulmonary Resuscitation in Older Surgical Patients

2021 ◽  
Author(s):  
Matthew B. Allen ◽  
Rachelle E. Bernacki ◽  
Bruce L. Gewertz ◽  
Zara Cooper ◽  
Joshua L. Abrams ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiopulmonary Resuscitation ◽  
Patient Preferences ◽  
Surgical Patients ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Healthcare Settings ◽  
Do Not Resuscitate Orders ◽  
Poor Outcomes ◽  
American Society

American Society of Anesthesiologists guidelines recommend that anesthesiologists revisit do-not-resuscitate orders preoperatively and revise them if necessary based on patient preferences. In patients without do-not-resuscitate orders or other directives limiting treatment however, “full code” is the default option irrespective of clinical circumstances and patient preferences. It is time to revisit this approach based on (1) increasing understanding of the power of default options in healthcare settings, (2) changing demographics and growing evidence suggesting that an expanding subset of patients is vulnerable to poor outcomes after perioperative cardiopulmonary resuscitation (CPR), and (3) recommendations from multiple societies promoting risk assessment and goal-concordant care in older surgical patients. The authors reconsider current guidelines in the context of these developments and advocate for an expanded approach to decision-making regarding CPR, which involves identifying high-risk elderly patients and eliciting their preferences regarding CPR irrespective of existing or presumed code status.

Choices of Seriously Ill Patients About Cardiopulmonary Resuscitation: Correlates and Outcomes

1996 ◽  
Vol 100 (2) ◽  
pp. 128-137 ◽  
Author(s):  
Russell S. Phillips ◽  
Neil S. Wenger ◽  
Joan Teno ◽  
Robert K. Oye ◽  
Stuart Youngner ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Seriously Ill Patients ◽  
Seriously Ill

Communication and Decision-Making in Seriously Ill Patients: Findings of the SUPPORT Project

2000 ◽  
Vol 48 (S1) ◽  
pp. S187-S193 ◽  
Author(s):  
Kenneth E. Covinsky ◽  
Jon D. Fuller ◽  
Kristine Yaffe ◽  
C. Bree Johnston ◽  
Mary Beth Hamel ◽  
...  
Keyword(s):  
Decision Making ◽  
Seriously Ill Patients ◽  
Seriously Ill
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