The experiences of adult patients, families, and healthcare professionals of CPR decision-making conversations in the United Kingdom: A qualitative systematic review

Aim: To conduct a qualitative systematic review on the experiences of patients, families, and healthcare professionals (HCPs) of CPR decisionmaking conversations in the United Kingdom (UK). Methods: The databases PubMed, Embase, Emcare, CINAHL, and PsycInfo were searched. Studies published from 1 January 2012 describing experiences of CPR decision-making conversations in the UK were included. Included studies were critically appraised using the CASP tool. Thematic synthesis was conducted. Results: From 684 papers identified, ten studies were included. Four key themes were identified: (i) Initiation of conversations -Key prompts for the discussion included clinical deterioration and poor prognosis. There are different perspectives about who should initiate conversations. (ii) Involvement of patients and families -HCPs were reluctant to involve patients who they thought would become distressed by the conversation, while patients varied in their desire to be involved. Patients wanted family support while HCPs viewed families as potential sources of conflict. (iii) Influences on the content of conversations -Location, context, HCPs' attitudes and emotions, and uncertainty of prognosis influenced the content of conversations. (iv) Conversation outcomes -Range of outcomes included emotional distress, sense of relief and value, disagreements, and incomplete conversations.Conclusions: There is inconsistency in how these conversations occur, patients' desire to be involved, and between patients' and HCPs' views on the role of families in these conversations. CPR discussions raise ethical challenges for HCPs. HCPs need training and pastoral support in conducting CPR discussions. Patients and families need education on CPR recommendations and support after discussions.

Michelle Hartanto, Gavin Moore, Timothy Robbins, Risheka Suthantirakumar, Anne-Marie Slowther