Do not attempt cardiopulmonary resuscitation practice and policy in Ireland: a mixed-methods study of service user and advocacy group perspectives.

Abstract

Background: Cardiopulmonary resuscitation offers the potential to save a person's life. However, this highly invasive medical treatment is not always appropriate, and the likelihood of success is relatively low. In Ireland, the Health Service Executive (HSE) National Consent Policy establishes the national guidance in respect of DNACPR decisions, and this was supplemented by HSE Guidance Regarding Cardiopulmonary Resuscitation and DNAR Decision-Making during the COVID-19 Pandemic. Previous research on DNACPR practice in Ireland concentrated on the perspective of the medical and nursing professions and was completed prior to publication of the supplementary guidance. In contrast, this article reports on research which investigates service user and advocacy group perspectives on DNACPR practice and policy in Ireland.

Methods: The research utilized mixed methods design to collect quantitative and qualitative data. A questionnaire with close-ended and open-ended questions was distributed via Qualtrics, targeting the public while explicitly excluding healthcare workers to focus on patient and caregiver experiences. Recruitment involved identifying relevant advocacy and state organizations and leveraging professional networks and social media to maximize participation and minimize selection bias. Recruitment was conducted through collaboration with organizations that advocate for individuals affected by DNACPR decisions. Survey data were analysed in SPSS for closed questions and thematic analysis for open responses. Four semi-structured interviews with representatives of advocacy groups were completed, transcribed and analysed using thematic analysis. The qualitative and quantitative data's reporting rigour was guided by the CROSS and SRQR guidelines.

Results: A total of 148 participants completed the survey, and 4 interviews were completed with representatives of advocacy groups; 70.5% (n = 98) selected the correct definition of a DNACPR decision. Many survey participants overestimated the rate of survival for both in-hospital and out-of-hospital cardiac arrest. There was a strong desire for involvement and support in the decision-making process. Interviewees drew attention to poor awareness of national policy, uncertainty as to the decision-making authority of family members and difficulties in communication. Interviewees also highlighted the need for additional information concerning the nature of DNACPR and CPR.

Conclusions: The research study highlights points of weakness in the DNACPR decision-making framework for service users. While there is a desire to be involved in the DNACPR decision-making process, this is challenged by deficiencies in the understanding of CPR and uncertainty surrounding decisional authority. The decision-making framework may be strengthened by the development of accessible information and educational resources.