Background Appropriate, anticipatory cardiopulmonary resuscitation (CPR) discussions and decisions are now an integral part of good clinical practice, and have been shown to reduce futile treatment and end-of-life distress.
CPR decisions have been established to rest with the most senior clinician, yet our hospital experience suggests that even the most junior of doctors can be involved in this process. For doctors in training this can represent one of the most difficult ethico-legal challenges they face, with reports of lack of confidence and formal teaching.
Aims The aim of the study was to explore our most junior doctors’ – ‘foundation doctors’ – experiences of discussing CPR with hospital in-patients and their relatives; to identify any training needs, and if required design and deliver an appropriate training intervention.
Methods An electronic survey using a semi-structured questionnaire was distributed to 118 foundation doctors working in East Kent University Hospital Foundation Trust. Simple percentage analysis of results was undertaken.
Results Response rate to the questionnaire was 45%. The majority of respondents did have experience of discussing CPR with patients/relatives, with 69% [31/45] reporting initiating such a discussion. A third of these doctors felt inadequately prepared for such discussions [‘not prepared’ or only ‘a little prepared’]. Many found the discussion difficult [34/40] and nearly half [18/40] found it distressing to some degree. Only a minority [6/45] reported having received formal postgraduate teaching on conducting CPR discussions, and most respondents [39/45] reported a need for further training.
Conclusion The majority of foundation doctors in this study had been involved in conversations about CPR. A significant number felt inadequately prepared for the task and the majority identified specific teaching and training needs. The investigators have collaborated to design an educational initiative for local foundation doctors based on identified needs which is currently being piloted.
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