title: Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.
abstract: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions.
  
  
  
  Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback.
  
  
  
  Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans.
  
  
  
  Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.
authors.affiliation: Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, 3056 Albany Highway, Armadale, 6112, Western Australia, Australia.|Health Strategy and Networks, System Policy and Planning, Department of Health, Government of Western Australia, 189 Royal Street, East Perth, 6004, Western Australia, Australia.|School of Medicine, University of Notre Dame, 32 Mouat St, Fremantle, 6959, Western Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Waldron
authors.affiliation: Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, 35 Stirling Hwy, Nedlands, 6009, Western Australia, Australia. claire.johnson@uwa.edu.au.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: John Hunter Hospital, Lookout Rd, New Lambton Heights, Newcastle, NSW, 2305, Australia.|Intensive Care, Newcastle Private Hospital, 14 Lookout Rd, New Lambton Heights, Newcastle, NSW, 2305, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Saul
authors.affiliation: Clinical Teaching - Public Hospitals and Curriculum Development Communication and Clinical Practice Domain, School of Medicine, University of Notre Dame, 32 Mouat St, Fremantle, 6959, Western Australia, Australia.
authors.forename: Heidi
authors.initials: H
authors.lastname: Waldron
authors.affiliation: Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, 3056 Albany Highway, Armadale, 6112, Western Australia, Australia.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Chong
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Kent St, Bentley, 6102, Western Australia, Australia.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Hill
authors.affiliation: Advance Care Planning Program, Northern Health, 85 Cooper St., Epping, VIC, 3076, Australia.|Medical School, University of Melbourne, Parkville, VIC, 3010, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hayes
mesh_terms: D032722:Advance Care Planning / Q000592:standards; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D000066491:Clinical Decision-Making; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008499:Medical Records; D008505:Medical Staff, Hospital / Q000193:education*; D010820:Physicians / Q000592:standards; D014741:Video Recording
keywords: Advance cardiopulmonary resuscitation; Advance care planning; CPR decision-making; Goals of care; Medical education