Specialist physician approaches to discussing cardiopulmonary resuscitation for frail older adults: a qualitative study

Background: Despite the impact and importance of end-of-life discussions, little is known about how physicians discuss cardiopulmonary resuscitation (CPR) with patients and their families. The necessary components for successful communication about CPR are poorly understood and an established framework to structure these conversations is lacking. Here, we were motivated to understand how physicians approach resuscitation planning with families when older patients have limited life expectancy and a high burden of illness. Method: Qualitative analysis was conducted of semi-structured interviews of 28 physicians of varying medical sub-specialties in a tertiary care hospital. Results: Most physicians explored the surrogates' goals and values, but few provided explicit information about the patients' overall health status or expected long-term health outcome related to CPR and underlying illnesses. Conclusion: There is considerable heterogeneity in physicians' approaches to CPR discussions. The principle of autonomy is dominant with less emphasis on providing adequate information for effective decision-making