Resuscitation planning in palliative care
For patients in the early stage of their disease, active interventions, such as admission to an intensive care unit, ventilatory support or cardiopulmonary resuscitation (CPR) may be appropriate in the event of rapid deterioration in their condition. However, as the patient approaches the end of their life, these measures are unlikely to be beneficial, and the outcome of CPR, in particular, is universally poor. When CPR is deemed to be of no benefit, it is still good clinical practice to explain to the patient or family or carers in a conversation about end-of-life care that CPR would not change the course of their illness, and the focus will instead be to ensure the patient’s comfortClayton, 2007.
Conversations about resuscitation and related issues can be difficult for healthcare professionals and patients and their families, and need to be managed sensitively; however, this is not a valid reason to avoid them. These discussions are particularly important when patients are admitted to hospital. Healthcare professionals should be aware of cultural sensitivities when raising the subject of resuscitation; for example, some people may not wish to discuss resuscitation, or may wish to discuss it only once and not be asked about it each time they are admitted to a hospital. For guidance, see Advance care planning conversations.
- 'I find it's really useful to talk about treatments that could be helpful if your health was deteriorating, and treatments that would not be useful. Would it be alright for me to talk about these things with you?'
- 'Have you ever talked about these things with your local doctor, or other specialists?'
- 'Would you be happy for me to discuss our conversation with your family and carers?'
After discussing resuscitation planning, document the agreed goals of care and specific resuscitation measures that will and will not be provided for a patient when they deteriorate. This information should be recorded in medical case notes, healthcare record kept in the home (eg bedside notebook or other patient-held record), and as part of an advance care plan. (It is important to note that resuscitation planning documents are not the same as advance care plans). In the case that an ambulance is called, it is particularly important that paramedics have access to such documentation to ensure that CPR or other resuscitation measures are not started inappropriately; see Communication of an advance care plan. Families and carers should also be aware of the patient’s preferences in relation to resuscitation measures, if appropriate.
Jurisdictions and healthcare services often have standard processes to ascertain and document whether acute resuscitation is appropriate for patients who are in hospital; see Advance care planning in hospitals.