Reflecting on an experience: CPR conversation

Here, a doctor uses Gibbs' reflective cycle to take positive learning from an unavoidably sad situation.

Description

What happened?

I was in a position where I had to inform a patient that their treatment for metastatic cancer was no longer responding to palliative treatment and therefore we needed to have a discussion about their CPR status.

Feelings

What were you thinking and feeling?

I felt really anxious about having this conversation - I had been caring for this patient for some time - they were a parent with young teenage children and I personally felt really sad that they had reached this point in their treatment. I also was concerned about my confidence to have this necessary conversation in a sensitive manner.

Evaluation

What was good and bad about the experience?

It was good that I had an existing relationship with this patient and their family. Previously, when discussing treatment options with both the patient and their partner I always felt that these had gone well and they felt able to openly discuss their concerns with me. With the patient's permission, their partner was also present. However, the ward was busy and it was not possible for to have this conversation in a private environment - it was by the bed in the ward.

Analysis

What sense can you make of the situation?

Looking back - despite my apprehension about having this discussion – it was a positive experience. On analysis I thought about factors that contributed to this.

  • The existing good relationship with the patient.
  • The way I opened the conversation. I had recently attended a training session with the hospital palliative care team where it was suggested that starting the conversation by asking the patients views on whether they would like to die naturally. I did this and found it a really helpful way to open the discussion about CPR.
  • I was open with the patient responding to their questions as honestly as I could.
  • I tried to create a private atmosphere in the ward. I had recently watched a video on talking about end of life care. On the video a consultant talked about having difficult conversations in the ward. She acknowledged that the situation is not ideal and describes strategies to address it like drawing the curtains, apologising to the patient that this isn't the best environment but then focussing on the patient - being at the same level, being attentive etc. So I tried to do these things and it really seemed to help with the interaction and made me feel less uncomfortable.

Conclusion

What else could you have done?

I am aware that I had this conversation with the patient on my own and in retrospect it would have been good if I had involved a nurse in the discussion. This would have helped in the continuing support for the patient and I think that I may have found this helpful if there were questions I couldn't address.

Action plan

If it arose again what would you do?
Next steps icon

As overall this was a positive experience the main action point would be the involvement of the nurse in the discussion with the patient.