The impact of language on the interpretation of resuscitation clinical care plans by doctors. A mixed methods study
Autoři:
Colette Dignam aff001; Josephine Thomas aff003; Margaret Brown aff004; Campbell H. Thompson aff001
Působiště autorů:
Division of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
aff001; Division of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
aff002; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
aff003; School of Psychology, Social Work, and Social Policy, Division of Education, Arts and Social Sciences, University of South Australia, Adelaide, South Australia, Australia
aff004
Vyšlo v časopise:
PLoS ONE 14(11)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225338
Souhrn
Introduction
Resuscitation clinical care plans (resuscitation plans) are gradually replacing ‘Not for Cardiopulmonary Resuscitation’ orders in the hospital setting. The 7-Step Pathway Resuscitation Plan and Alert form (7-Step form) is one example of a resuscitation plan. Treatment recommendations in resuscitation plans currently lack standardised language, creating potential for misinterpretation and patient harm.
Aims
To explore how terminology used in resuscitation plans is interpreted and applied by clinicians.
Method
A mixed methods study surveyed 50 general medical doctors, who were required to interpret and apply a 7-Step form in three case vignettes and define seven key terms. Statistical analysis on multiple choice and thematic analysis on free-text responses was performed.
Results
Terminology was inconsistently interpreted and inconsistently applied, resulting in clinically significant differences in treatment choices. Three key themes influenced the application of a resuscitation plan: in-depth discussion, precise documentation and personal experience of the bedside deciding doctor.
Discussion
This study highlights persistent communication deficiencies in resuscitation plan documentation and how this may adversely affect patient care; findings unlikely to be unique to Australia or South Australia.
Conclusion
Removing ambiguity by standardising and defining the terminology in resuscitation plans will improve bedside decision-making, while also supporting the rights of the patient to receive appropriate and desired care.
Klíčová slova:
Critical care and emergency medicine – Resuscitation – Medical doctors – Cancer treatment – Antibiotics – Decision making – Oxygen – Language
Zdroje
1. Fritz Z, Slowther AM, Perkins GD. Resuscitation policy should focus on the patient, not the decision. BMJ. 2017;356:1–6.
2. Citko J, Moss AH, Carley M, Tolle S. The National POLST Paradigm Initiative, 2nd Edition #178. J Palliat Med. 2011;14:241–2. doi: 10.1089/jpm.2010.9730 21314577
3. Health SA. Resuscitation Plan 7 Step Pathway for Health Professionals. Department for Health and Ageing. South Australia: Government of South Australia; 2014. (Accessed 16 June 2019, at www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/end+of+life+for+health+professionals/resuscitation+plan+7+step+pathway+for+health+professionals)
4. Dignam C, Brown M, Thompson CH. Changes in resuscitation and end-of-life documentation in older patients' clinical case notes: A comparison of 2011 and 2017 practice. Australas J Ageing. 2019;38:28–32. doi: 10.1111/ajag.12587 30239083
5. Fritz Z, Pitcher D, Regnard C, Spiller J, Wang M. ReSPECT is a personal emergency care plan summary. BMJ. 2017;357:j2213. doi: 10.1136/bmj.j2213 28487394
6. Patient Care Quality Office. Medical Orders for Scope of Treatment (MOST). Interior Health Authority. British Columbia, Canada. (Accessed 18 June 2019 at www.interiorhealth.ca/YourCare/PalliativeCare/ToughDecisions/Pages/Medical-Orders-for-Scope-of-Treatment-(MOST).aspx)
7. Hui D, De La Cruz M, Mori M, Parsons HA, Kwon JH, Torres-Vigil Iet al. Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks. Support Care Cancer. 2013;21:659–85. doi: 10.1007/s00520-012-1564-y 22936493
8. Fadel MG, Parekh K, Hayden P, Krishnan P. Improving resuscitation decisions: a trust-wide initiative. BMJ Open Qual. 2018;7:e000268. doi: 10.1136/bmjoq-2017-000268 30515464
9. Schmidt TA ZD, Fromme EK, Cook JN, Tolle SW. Physician orders for life-sustaining treatment (POLST): lessons learned from analysis of the Oregon POLST Registry. Resuscitation. 2014;85:480–5. doi: 10.1016/j.resuscitation.2013.11.027 24407052
10. Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet e‐surveys (cherries). Journal of medical Internet research. 2014; 6(3)e34
11. Braun V, Clarke V. What can "thematic analysis" offer health and wellbeing researchers? Int J Qual Stud Health Well-being. 2014;9:26152. doi: 10.3402/qhw.v9.26152 25326092
12. Zanartu C, Matti-Orozco B. Comfort measures only: agreeing on a common definition through a survey. Am J Hosp Palliat Care. 2013;30:35–9. doi: 10.1177/1049909112440740 22495795
13. Beach MC, Morrison RS. The effect of do-not-resuscitate orders on physician decision-making. J Am Geriatr Soc. 2002;50:2057–61. doi: 10.1046/j.1532-5415.2002.50620.x 12473020
14. Akhunbay-Fudge CY, Buss I, Ward A, Snead C, Cole M, Coulter A. Improving handover of patient care using a new weekend proforma with a focus on ceiling of care. BMJ Qual Improv Rep. 2014;3.
15. Shermon E, Munglani L, Oram S, William L, Abel J. Reducing DNACPR complaints to zero: designing and implementing a treatment escalation plan using quality improvement methodology. BMJ Open Qual. 2017;6:e000011. doi: 10.1136/bmjoq-2017-000011 28959774
16. Australian Commission on Safety and Quality in Health Care. National Consensus Statement: essential elements for safe and high-quality end-of-life care. Sydney: ACSQHC, 2015.
17. National POLST paradigm. National POLST form: Portable Medical Order. Tides Centre. Washington, USA. (Accessed 11 September 2019 at https://polst.org/national-form/?pro=1)
Článok vyšiel v časopise
PLOS One
2019 Číslo 11
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