CPR-Directive Conversations in the Emergency Department: The Opinion of Elderly Patients

Abstract

Background The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions. Objectives This study aimed to determine which healthcare professionals that elderly patients admitted via the ED preferred to discuss their CPR directive with and their opinion about the ED as a setting for discussing their CPR directive. Methods A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients who indicated that they preferred to discuss their CPR-directive conversation with a physician working in the ED were invited for follow-up semi-structured interviews. Results General practitioners (GP) were the most preferred healthcare professionals for a conversation about CPR directives (64%). However, physicians working in the ED were the second most preferred medical professionals (51%) along with medical specialists (51%). Only 6% of patients did not consider a physician in the ED as a suitable option for these conversations. Interviewed patients saw a physician consultation in the ED as an opportunity to: 1) check and update their CPR directive, 2) get information about the content and consequences of CPR considering their current health status, and 3) prevent the use of undesired medical treatment during admission. Conclusions Although GPs were the most preferred healthcare professionals with whom to discuss CPR preferences, an unexpectedly large proportion of the investigated population preferred to discuss their choices with a physician working in the ED. These considered these discussions of In conclusion, this study demonstrates that elderly patients admitted to a hospital ward via the ED identified their GP as the most preferred health professional with which to discuss their CPR preferences. However, a significant part of the study population answered in our questionnaire that they also prefer to discuss this topic at the time of admission with a physician in the ED. Interviews showed that a conversation with a physician in the ED was primarily considered suitable based on their decline in health before admission and the expected level of expertise in acute care of the physician in the ED. The results suggest that the topic is on average less repulsive for elderly patients than healthcare providers might think and that, for a significant part of elderly patients, engaging in these conversations is a key aspect of patient-centered healthcare.