Twitter helped me decide that I’m not for resuscitation

Using social media

Mark accepted my reaction, but it became clear that he thought that many people have a rose-tinted view of how successful cardiopulmonary resuscitation is, perhaps because of the way it is portrayed on television. He suggested I look at the TalkCPR website and videos on http://talkcpr.wales and search for the #TalkCPR hashtag he has set up on Twitter, to understand more about CPR in palliative care settings.

So off I went, followed Mark on Twitter, looked at some of the debates and the videos that he helped create with patients and carers. The first thing I took in was the low success rates of cardiopulmonary resuscitation for patients when the cancer has spread. And then of course I read about what cardiopulmonary resuscitation involves.

Changing my mind

At subsequent visits to see Mark, I gradually changed my mind. At first I thought that conditional cardiopulmonary resuscitation might be acceptable. We terminally ill cancer patients live in hope that a cure for our cancer will be found “tomorrow.”

But when I discussed it further and reflected on it as “just one procedure of many,” albeit an invasive and traumatic one which was unlikely to work, I asked for a DNACPR form to be filled in. I specified my views, in particular stating that I would still be keen to be considered for anticancer treatments such as chemotherapy. But when it comes to one particular intervention—cardiopulmonary resuscitation—I do not want it. The main influence of my decision was the success rate and the possible damage to my physical body that would make survival with quality of life almost impossible.

Mark and his colleagues tell me that they still see many instances where the absence of a DNACPR or Advance Decision to Refuse Treatment form, means that healthcare workers start resuscitation by default, even in patients where a natural, irreversible dying process has started.

Talking to loved ones

It is not easy to contemplate your own death, but I approach it with some black humour, and my palliative care and oncology team are also good at sharing a laugh about some of the crazy things we discuss. I keep the form with me at all times, so healthcare professionals can be aware of my wishes, and I’ve told everyone around me about it. My (grown up) children were the first to know my decision at each stage and how I had arrived at my final decision of DNACPR.

I’d like doctors and nurses who have these discussions often to take the time to talk about the complex issues with patients and their loved ones to create a shared decision process. Cardiopulmonary resuscitation in palliative care is difficult to discuss and some people may find it distressing, but doing so early means having informed patients who know the pros and cons and can have an intelligent conversation with their healthcare professional. Also they can explain their views to family and friends.