Contributions
Abstract: PB2376
Type: Publication Only
Background
Cardiopulmonary resuscitation (CPR) was introduced in the 1960’s as a treatment in the context of sudden cardiac arrest due to arrhythmias, most commonly due to acute Myocardial Infarction. As awareness spread and equipment improved it became more common in other situations, and it has become increasingly recognised that this is not always appropriate. In fact, it can even expose patients to invasive and intensive physical treatment which may at best be briefly successful. Anticipatory decisions are a way to prevent palliative patients from being subjected to the trauma and indignity of CPR where there is no real prospect of benefit. However it is clearly a difficult and potentially distressing topic for patients, families and healthcare professionals alike. Guidance exists in the UK in the form of 'Decisions relating to cardiopulmonary resuscitation guidance 2016' which states 'Whenever possible making specific anticipatory decisions about whether or not to attempt CPR is an important part of good-quality care for any person who is approaching the end of life and/or is at risk of cardiorespiratory arrest.'
This is a highly important aspect of patient care, and is an area of continual improvement for in order to ensure ensuring the best care for dying patients and their families.
Aims
To analyse the DNACPR discussions taking place in the context of acute admissions to a tertiary oncology and haematology centre in order to try and improve clinical practice.
Areas included were: intent of current treatment, reason for acute admission, evidence of previous resuscitation discussions in out-patient clinics or the community, the timing of DNACPR decisions in the context of the acute admission and time of death, grade of doctors carrying out discussions and the clinical context in which this was taking place.
Methods
Retrospective analysis of 41 sets of notes of deceased Haemato-Oncology and Oncology patients, identified through monthly divisional mortality and morbidity meetings.
Results
66% of patients identified were undergoing palliative treatment at the time of admission, and the most common reasons for admission included general decline/disease progression (29%)and infection (32%). Overall 15% of patients had evidence of previous DNACPR decisions or end of life discussions prior to admission.
51% of patients who passed away had DNACPR decisions made within 3 days of admission and 49% of patients died within one week of admission.
In 61% of patients this discussion was carried out by a junior doctor and 56% of patients were acutely or critically unwell at the time of discussion.
Conclusion
DNACPR are a key element of good and patient-centred care, allowing patients to die with dignity and have input into their end of life care. This review shows that significant changes in practice are required in order to improve the care delivered to patients with incurable malignant diagnoses. It highlights the importance of the early recognition of the palliative patient or patients in whom CPR would be unlikely to be successful. Equally important is the understanding and recognition by physicians as well as the communication to patients and relatives, that DNACPR decisions do not affect ongoing cancer treatment; ideally these discussions are carried out by a senior member of the team who knows the patient well. This review has increased DNACPR awareness, discussions and trasparency in our department.
In this era of ever-developing and increasing lines of often palliative treatments these discussions and decisions are more relevant than ever.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Abstract: PB2376
Type: Publication Only
Background
Cardiopulmonary resuscitation (CPR) was introduced in the 1960’s as a treatment in the context of sudden cardiac arrest due to arrhythmias, most commonly due to acute Myocardial Infarction. As awareness spread and equipment improved it became more common in other situations, and it has become increasingly recognised that this is not always appropriate. In fact, it can even expose patients to invasive and intensive physical treatment which may at best be briefly successful. Anticipatory decisions are a way to prevent palliative patients from being subjected to the trauma and indignity of CPR where there is no real prospect of benefit. However it is clearly a difficult and potentially distressing topic for patients, families and healthcare professionals alike. Guidance exists in the UK in the form of 'Decisions relating to cardiopulmonary resuscitation guidance 2016' which states 'Whenever possible making specific anticipatory decisions about whether or not to attempt CPR is an important part of good-quality care for any person who is approaching the end of life and/or is at risk of cardiorespiratory arrest.'
This is a highly important aspect of patient care, and is an area of continual improvement for in order to ensure ensuring the best care for dying patients and their families.
Aims
To analyse the DNACPR discussions taking place in the context of acute admissions to a tertiary oncology and haematology centre in order to try and improve clinical practice.
Areas included were: intent of current treatment, reason for acute admission, evidence of previous resuscitation discussions in out-patient clinics or the community, the timing of DNACPR decisions in the context of the acute admission and time of death, grade of doctors carrying out discussions and the clinical context in which this was taking place.
Methods
Retrospective analysis of 41 sets of notes of deceased Haemato-Oncology and Oncology patients, identified through monthly divisional mortality and morbidity meetings.
Results
66% of patients identified were undergoing palliative treatment at the time of admission, and the most common reasons for admission included general decline/disease progression (29%)and infection (32%). Overall 15% of patients had evidence of previous DNACPR decisions or end of life discussions prior to admission.
51% of patients who passed away had DNACPR decisions made within 3 days of admission and 49% of patients died within one week of admission.
In 61% of patients this discussion was carried out by a junior doctor and 56% of patients were acutely or critically unwell at the time of discussion.
Conclusion
DNACPR are a key element of good and patient-centred care, allowing patients to die with dignity and have input into their end of life care. This review shows that significant changes in practice are required in order to improve the care delivered to patients with incurable malignant diagnoses. It highlights the importance of the early recognition of the palliative patient or patients in whom CPR would be unlikely to be successful. Equally important is the understanding and recognition by physicians as well as the communication to patients and relatives, that DNACPR decisions do not affect ongoing cancer treatment; ideally these discussions are carried out by a senior member of the team who knows the patient well. This review has increased DNACPR awareness, discussions and trasparency in our department.
In this era of ever-developing and increasing lines of often palliative treatments these discussions and decisions are more relevant than ever.
Session topic: 36. Quality of life, palliative care, ethics and health economics