Barriers to involving older people in their resuscitation decisions: the primary–secondary care mismatch highlights the potential role of general practitioners

Authors

  • C. L. Holland,

    1. Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
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  • L. K. Bowker,

    1. Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
    2. Academic Department of Medicine for the Elderly, Norfolk and Norwich University Foundation Hospital, Norwich, Norfolk, UK
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  • P. K. Myint

    1. Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
    2. Academic Department of Medicine for the Elderly, Norfolk and Norwich University Foundation Hospital, Norwich, Norfolk, UK
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  • Disclosures None declared

Lesley K. Bowker, Academic Department of Medicine for the Elderly, Norfolk and Norwich University Foundation Trust, Colney Lane, Norwich, NR4 7UY, Norfolk, UK
Tel.: 01603 286613
Fax: 01603 286428
Email: lesley.bowker@nnuh.nhs.uk

Summary

Background:  ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) orders are made frequently for older people in hospital. Sensitive anticipatory discussion is encouraged where possible, but usually this does not happen, despite the evidence suggesting that many older patients would like to be involved in such decisions.

Methods:  Current clinical practice in both primary care and secondary care and perceived barriers to patient involvement in resuscitation decisions was assessed using a questionnaire in Medicine for the Elderly physicians in two hospitals, and General Practitioners of teaching practices in Norfolk.

Results:  Response rate was 51% (= 24/47). Hospital-based clinicians made DNACPR decisions more frequently, but discussed decisions with patients in less than 25% of cases. By contrast, GPs thought that patient involvement was more important and felt that they had a better understanding of the patient’s wishes due to the long-term relationship they shared. Mental capacity was seen as the biggest barrier to patient involvement by both groups. Other barriers included lack of understanding, communication difficulties and practical concerns.

Conclusion:  Further support and training could help clinicians improve their resuscitation decision-making practice. Advanced discussion in Primary Care with older people before they lose capacity may have a role in increasing their involvement in resuscitation decision making.

Ancillary