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A Comparison of Attitudes of Physicians and Patients Regarding Communication and Decision-making in End-of-life Issues and Cardiopulmonary Resuscitation at the University Hospital of the West Indies, Mona, Jamaica



Background: There is evidence suggesting that the discussions regarding cardiopulmonary resuscitation (CPR) and other end-of-life (EOL) issues are difficult for both physicians and patients and occur less frequently than is desirable. This may result in management decisions being inadvertently at variance between physicians and patients.
Aim: To determine the attitudes of physicians and patients attending outpatient clinics towards CPR and EOL issues at the University Hospital of the West Indies (UHWI), Jamaica.
Methods: This was an observational, questionnaire-based study. An 18-item self-administered questionnaire was used to assess physicians’ attitudes and a separate 21-item questionnaire was administered to clinic attendees from the medical and surgical subspecialities.
Results: Most of the physicians (95%) and patients (89%) believed in a patient’s right to choose or refuse CPR. Both groups supported shared decision-making, though the patients wanted this only if they are incapacitated. The physicians were not regularly initiating discussions with patients about CPR and EOL issues, with 37% of them indicating that they conducted these discussions only “sometimes” and 20% never had these discussions. The physicians’ lack of confidence in their communication skills may be contributory; only 50% of them felt that their skills were “frequently” or “always” adequate. The patients expressed their willingness to have discussions with their physicians (73%), but many preferred to have these discussions only in the event of complications (56%).
Conclusion: The study suggests that communication about resuscitation between physicians and patients in our institution is suboptimal and improvement is needed. Formal training in communicating difficult issues should be introduced in undergraduate and postgraduate courses and reinforced during an ongoing continuing medical education. 
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e-Published: 22 Dec, 2017
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