Steri-etal2018
| Steri-etal2018 | |
|---|---|
| BibType | ARTICLE |
| Key | Steri-etal2018 |
| Author(s) | Anca-Cristina Sterie, Etienne Rochat, Eve Rubli Truchard, Ralf J. Jox |
| Title | Talking about the meaning of life in code-status conversations between elderly hospitalized patients and their physicians |
| Editor(s) | |
| Tag(s) | EMCA, CPR, Medical CA, Elderly, Swiss |
| Publisher | |
| Year | 2018 |
| Language | English |
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| Month | |
| Journal | Journal of Pain and Symptom Management |
| Volume | 56 |
| Number | 6 |
| Pages | e47 |
| URL | Link |
| DOI | 10.1016/j.jpainsymman.2018.10.474 |
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Abstract
Objectives Physicians are required to establish whether cardio-pulmonary resuscitation (CPR) is medically indicated and desired by hospitalized patients, in particular when advanced age and severe illness challenge the prospects of CPR. Using a naturalistic setting, we aimed to explore how elderly patients deliver and justify their preference with regard to CPR.
Methods In a multi-method qualitative study, we collected 40 audio-recordings of patient-physician CPR discussions on admission to a Swiss geriatric rehabilitation facility. To analyze the recordings and transcripts we used Thematic and Conversation Analysis.
Results When physicians ask about CPR, patients frequently deliver their responses as ‘packages', consisting of their preference regarding CPR and an explanation that refers to existential issues, conveying their attitude towards life or death. Examples: Physician 1: If your heart stopped, should we try to massage it? Patient 1: Yes, why not? I still enjoy living. Physician 2: If something happens, if the heart stops'¦ Patient 2: You shouldn't restart it'¦ You know, I am at the end of the rope now at 88. Most statements about underlying life attitudes are spontaneously expressed by patients and provide justifications of their preferences regarding CPR. Their recurrence indicates that patients seem to consider their decision contrary to the expectations of the physicians, and therefore in need of clarification. Nevertheless, these justifications give access to the patient's values and spirituality concerns, for example regarding the meaning of life, a resource which could enable physicians to better understand their patients' preferences.
Conclusions The CPR discussion is an opportunity for physicians to understand their patients' decision and get a better sense of their values and goals. The results of this study can be used to improve physicians' training regarding the communicative approach to sensitive issues such as CPR and discussing emerging spiritual concerns, in particular with elderly and palliative patients.
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