Resuscitation in cancer. Comparison of patient and health staff preferences.
One hundred oncology patients from a major teaching hospital and their treating health staff were studied in the second phase of research examining attitudes towards cardiopulmonary resuscitation (CPR). A descriptive approach was used incorporating semistructured interviews of patients and established questionnaire measures, examining knowledge of and attitude towards disease and treatment, psychological functioning, and current and projected attitude toward resuscitation. Health staff also participated in a semistructured interview. This phase of the project focused particularly on a direct comparison of patient and staff assessments. In current circumstances, 10% of patients refused resuscitation. This was associated with disease of good prognosis. In a future hypothetical deteriorated scenario presented to patients, 39% declined resuscitation. This was associated with a past history of suicidal behavior. In current circumstances, health staff designated 14% of patients "Do-Not-Resuscitate" (DNR)--this was associated with a number of variables considered to predict poor outcome in resuscitation. In the future scenario, staff designated 54% of patients DNR--this was associated again with poor resuscitation outcome variables, but also independently, with a past psychiatric history. Comparison of patient and health staff preferences for resuscitation showed moderate yet significant concordance in current circumstances but not in the future scenario. The findings indicate firstly the feasibility of discussing resuscitation preferences with seriously ill patients and secondly an urgent need to improve patient and staff discussions regarding resuscitation, as staff and patients' attitudes to resuscitation differ.
Owen
C
C
University of Sydney, Australia.
Tennant
C
C
Levi
J
J
Jones
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D010348:Patient Care Team; D010358:Patient Participation / Q000523:psychology*; D018579:Patient Selection; D010552:Personality Assessment; D011788:Quality of Life; D016414:Resuscitation Orders / Q000523:psychology*; D012803:Sick Role; D015996:Survival Rate; D016896:Treatment Outcome