Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study
Abstract Background Emergency medical services (EMS) must incorporate the patient’s physiologic state and end-of-life wishes when determining whether to initiate and/or continue cardiopulmonary resuscitation (CPR). This study aims to describe and analyze the use of advance directives (ADs) in CPR by...
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| Format: | Article |
| Language: | English |
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BMC
2024-11-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-024-00763-6 |
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| author | Pierre-Élie Ménégaux Aline Chassagne Abdo Khoury Tania Marx |
| author_facet | Pierre-Élie Ménégaux Aline Chassagne Abdo Khoury Tania Marx |
| author_sort | Pierre-Élie Ménégaux |
| collection | DOAJ |
| description | Abstract Background Emergency medical services (EMS) must incorporate the patient’s physiologic state and end-of-life wishes when determining whether to initiate and/or continue cardiopulmonary resuscitation (CPR). This study aims to describe and analyze the use of advance directives (ADs) in CPR by emergency physicians (EPs). Methods A qualitative approach using semi-directed interviews was conducted. EPs were confronted with three fictitious clinical situations where they would have to take under their care a young patient with no previous history or treatment, presenting with a cardiac arrest and a do not attempt CPR (DNACPR) order. Results Twenty EPs, 10 men and 10 women (mean age 39.7 ± SD 11,21), were included either for individual interviews or a focus group. Without the AD, EPs all declared that they would have started CPR. With the AD, 6 physicians accepted ADs and did nothing, 5 physicians performed a time-limited trial to allow time for collegial discussion, and 9 physicians rejected ADs alone and resuscitated. Inductive analysis of the verbatims identified 4 themes (reflection, assessment of the medical situation, determining the validity of ADs, cognitive dissonance) and the opposability of ADs to medical decisions was the point of divergence within the focus group. Conclusion This difference seems to be explained by different thought processes, notably concerning two steps: determining the validity of ADs, and the cognitive dissonance induced by the situation. EPs seem to respect ADs in cardiac arrest when determining the validity of ADs can be quick and the physician understands why the AD was written. |
| format | Article |
| id | doaj-art-de8eaec3d8a34eaf87a9719b758599e7 |
| institution | OA Journals |
| issn | 1865-1380 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj-art-de8eaec3d8a34eaf87a9719b758599e72025-08-20T02:08:24ZengBMCInternational Journal of Emergency Medicine1865-13802024-11-011711810.1186/s12245-024-00763-6Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative studyPierre-Élie Ménégaux0Aline Chassagne1Abdo Khoury2Tania Marx3Department of Emergency Medicine and Critical Care, CHU BesançonUMR INSERM 1322 LINC, Université de Franche-ComtéDepartment of Emergency Medicine and Critical Care, CHU BesançonDepartment of Emergency Medicine and Critical Care, CHU BesançonAbstract Background Emergency medical services (EMS) must incorporate the patient’s physiologic state and end-of-life wishes when determining whether to initiate and/or continue cardiopulmonary resuscitation (CPR). This study aims to describe and analyze the use of advance directives (ADs) in CPR by emergency physicians (EPs). Methods A qualitative approach using semi-directed interviews was conducted. EPs were confronted with three fictitious clinical situations where they would have to take under their care a young patient with no previous history or treatment, presenting with a cardiac arrest and a do not attempt CPR (DNACPR) order. Results Twenty EPs, 10 men and 10 women (mean age 39.7 ± SD 11,21), were included either for individual interviews or a focus group. Without the AD, EPs all declared that they would have started CPR. With the AD, 6 physicians accepted ADs and did nothing, 5 physicians performed a time-limited trial to allow time for collegial discussion, and 9 physicians rejected ADs alone and resuscitated. Inductive analysis of the verbatims identified 4 themes (reflection, assessment of the medical situation, determining the validity of ADs, cognitive dissonance) and the opposability of ADs to medical decisions was the point of divergence within the focus group. Conclusion This difference seems to be explained by different thought processes, notably concerning two steps: determining the validity of ADs, and the cognitive dissonance induced by the situation. EPs seem to respect ADs in cardiac arrest when determining the validity of ADs can be quick and the physician understands why the AD was written.https://doi.org/10.1186/s12245-024-00763-6Cardiac arrestEmergency medical servicesAdvance directiveDo-not-attempt-cardiopulmonary-resuscitation ordersEthicsDecision-making |
| spellingShingle | Pierre-Élie Ménégaux Aline Chassagne Abdo Khoury Tania Marx Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study International Journal of Emergency Medicine Cardiac arrest Emergency medical services Advance directive Do-not-attempt-cardiopulmonary-resuscitation orders Ethics Decision-making |
| title | Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study |
| title_full | Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study |
| title_fullStr | Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study |
| title_full_unstemmed | Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study |
| title_short | Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study |
| title_sort | consideration of advance directives by emergency physicians in patients with cardiac arrest a clinical vignettes based qualitative study |
| topic | Cardiac arrest Emergency medical services Advance directive Do-not-attempt-cardiopulmonary-resuscitation orders Ethics Decision-making |
| url | https://doi.org/10.1186/s12245-024-00763-6 |
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