I’ve been asked several times about the work I did that was accepted at the European Association of Palliative Care EAPC conference 2016
Some of it is summarised in an earlier post.
And the poster is here
But here are both the abstracts:
Primary Care Staff Knowledge of CPR Survival Rate
There is an ongoing push for primary care staff in the UK to implement Advance Care Plans for terminally and chronically ill patients, including DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders as appropriate. Recent UK legal judgements have underlined the importance of involving patients or families, and also established the ‘prudent patient’ approach to informed consent.
Background/aims: There is an ongoing push for primary care staff in the UK to implement Advance Care Plans for terminally and chronically ill patients, including DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders as appropriate. Recent UK legal judgements have underlined the importance of involving patients or families, and also established the ‘prudent patient’ approach to informed consent.
Studies in secondary care have demonstrated poor staff (as well as patient) knowledge of CPR survival rates. This study investigates primary care staff knowledge of CPR survival rates: this is important if patients and their families are to be informed and involved in DNACPR orders.
Methods: A forced-choice questionnaire was administered to primary care staff attending relevant educational events and via service providers in a London borough.
The questionnaire asked about responsibility for DNACPR orders and other more contextualised resuscitation decisions. It also asked about perceived survival rates in out-of-hospital, and in-hospital CPR; including in patients aged over 70, and in those with advanced cancer.
Results: Very few primary care staff in this survey accurately estimated CPR survival rates: there were substantial under- and over-estimates, for all patient ages. Most staff have signed off five or less DNACPR orders. Those who have signed more did not always have more accurate knowledge about survival rates.
Conclusions: If ‘prudent’ primary care patients are going to be able to fully embrace the new approach to consent, they need to know more about the outcomes of CPR, especially out-of-hospital. It must therefore be of concern that so many primary care staff had such limited knowledge about CPR survival rates. Both under- and over-estimates may inappropriately influence decision-making.
The upcoming UK national approach considers decisions about CPR within overall goals of care, but may produce new gaps in knowledge for primary care staff.
Abstract number: P300 (published here)
Abstract type: Poster
Survival after Out-of-Hospital CPR in Terminally and Chronically Ill Patients
Background/aims: There is good evidence both that patients (and staff) have unrealistic expectations about CPR survival, and that patients change their resuscitation preferences depending what outcomes they expect. A recent UK legal judgement suggests that consent should be as for a ‘prudent patient’. To implement this approach for CPR we, ideally, need more pre-arrest and patient-specific information.
This study collates published evidence about patient-level prognostic factors for CPR survival. With the current push for deaths at home, it concentrates on out-of-hospital cardiac arrests (OHCAs).
Methods: A literature review considered OHCA survival rates in terminally and chronically ill patients, with a special focus on high burden clinical conditions. The potential effects of patient age and functional status were also considered.
Results: Although there is relatively little published evidence, older, sicker and frailer patients have very low survival levels after CPR. OHCA survival is especially low for patients with advanced cancer, or advanced liver disease, or with dementia. Contradictory results for patients with multiple co-morbidities, or with other specific conditions, are partly explained by methodological issues. Importantly, the low CPR survival rates in the terminally and chronically ill are artificially inflated: resuscitation preferences change as clinical status worsens, and more of the sicker patients choose to avoid CPR.
Conclusions: Although the methodological issues make individual estimates impossible, patients and doctors need to know about the low survival rates following OHCA in patients with terminal and chronic illnesses. Discussions about resuscitation preferences may need to be revisited as patients get sicker, frailer and older. The forthcoming UK national approach considering decisions about CPR within overall goals of care and focusing on what treatments will be given rather than specifically on withholding CPR, may help here.
Abstract number: PO183 (published here)
Abstract type: Print Only