An exploration of cardiopulmonary resuscitation discussions with ethnically diverse patients and their families

Abstract

Background/Aims Little is known about how current UK policy for end-of-life care planning fits with the social, cultural and religious values and beliefs of ethnic minority communities. This study aimed to explore the perspectives of patients and family caregivers from ethnically diverse backgrounds, as well as the views of health professionals, regarding end-of-life care planning, including discussions about cardiopulmonary resuscitation. Methods A qualitative study was conducted, including comparative thematic and cross-case analysis from 18 longitudinal patient case studies and 19 interviews with bereaved family members. A total of 112 interviews were conducted across patients, family caregivers and health professionals. Topics included experiences of talking about illness, discussions about choices and decisions about future care, such as cardiopulmonary resuscitation decision making. Results Health professionals sought to identify when patients were ‘ready’ for end-of-life care discussions before initiating these conversations. However, little clarity was given around the characteristics that constituted this readiness by any of the health professionals. Issues around translation, such as mistranslation, confidentiality issues with external translators and the potential for family caregivers to misconstrue information in translation were also highlighted. Religious and cultural beliefs played significant roles in patients' do not attempt cardiopulmonary resuscitation decisions, with anxieties around whether the system adequately valued these beliefs. Conclusions Health professionals played a significant role in seeking an agreement on do not attempt cardiopulmonary resuscitation. Participants' accounts of the discussions highlight the importance of insightful professional recognition of ‘readiness’ to broach the topic, as well as a good knowledge of family dynamics. It also raises concerns about the risk of the patient's voice being unduly influenced by health professionals and/or family caregivers, especially in cases where an interpreter is required to mediate communication.