Short CommunicationDevelopment and use of a decision aid for communication with hospitalized patients about cardiopulmonary resuscitation preference☆
Introduction
Improving communication and decision-making is important for end-of-life care [1], [2], [3], [4]. In hospitals, discussions about cardiopulmonary resuscitation (CPR) preferences are the most common form of such communication but occur for less than 30% of seriously ill patients [5]. Moreover, when it occurs, patients and family members may not have the necessary information to make a quality decision on this important issue [6], [7].
Patient decision aids are “tools that help people become involved in decision-making by providing information about the options and outcomes and by clarifying personal values” [8]. Given the lack of published decision aids, we attempted to develop a decision aid to facilitate discussions and improve decision-making about CPR preferences in hospitalized patients. The purpose of this paper is to describe the developmental process and how we evaluated the aid for validity, feasibility and acceptability.
Section snippets
Development
Content and format were based on the available evidence, previously published research, and expert clinical experience [2], [5], [9], [10], [11]. The decision aid was developed for a shared decision-making model with three analytical steps: information exchange, deliberation, and decisional responsibility [12]. ‘Discussions’ represent a key aspect of the decision-making process; the information exchange and deliberation process. The decision aid was developed to facilitate all aspects of
Results
Input from clinicians led to changes in format and in content, including the development of a table to review advantages and disadvantages of CPR. This was done to address a perceived bias against choosing CPR.
Clinicians and patients/families felt patients should receive the document soon after admission to hospital. Clinicians felt they could use the tool either as a preparation for discussion or during the discussion itself. Focus group participants suggested that nurses could use the
Discussion
In this project, we developed a decision aid that meets the majority of the CREDIBLE criteria for decision aids [8].
The use of the aid with hospitalized patients was felt to be feasible by participants. Patients and family members were polarized with respect to their preferences about CPR, suggesting that the decision aid would help participants make a decision. More patients reported to be “leaning away” from CPR but this may also reflect the nature of subjects; older with significant medical
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Funding support from the Canadian Researchers at the End of Life Network (CARENET).
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For the Canadian Researchers at the End of Life Network (CARENET).