An article on how to discuss ceiling of care (including resuscitation); this is something I do with every new patient at the care home I cover (or with their family, if the resident isn’t able to have that discussion) so I read this with interest. Suggestions:
- Start with a discussion of the person’s understanding of his or her condition and correction of any unrealistic expectations
- Explain the different views people have on the types of treatment that they would want in the case of sudden illness (this is pretty much what I do already).
- Explore what’s important to the patient for the future; what things do they like doing and want to be able to continue, or to start doing again? What could help them with this?
- What aims of treatment are important to them, particularly in terms of comfort vs. sustaining life and how these things balance out?
And then discuss specifics of CPR and admission.
One other helpful suggestion was that, in cases of disagreement, a second opinion should be offered and arranged.