What investigations and procedures do patients in hospices want

Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: A meta-analysis

INTRODUCTION

Cardiopulmonary resuscitation is thought to be a low-yield intervention in cancer patients. In patients with metastatic disease the procedure is thought to be futile. Comprehensive data on survival to discharge in subsets of cancer patients undergoing in-hospital cardiopulmonary resuscitation, however, are lacking.

OBJECTIVE

To determine the rate of survival to discharge for adult cancer patients undergoing in-hospital cardiopulmonary resuscitation.

METHOD

A systematic search of MEDLINE and our primary sources' references was performed for studies involving in-hospital cardiac arrest, in clearly defined subsets of adult cancer patients, with outcomes that included survival to hospital discharge.

RESULTS

Forty-two studies from 1966-2005, comprising 1707 patients met our minimal inclusion criteria. Overall survival to discharge was 6.2%. Survival in patients with localized disease was 9.5%, and in patients with metastatic disease was 5.6%. Analysis of data reported since 1990 reveals a narrowing of the survival gap, with survival rates in patients with localised disease of 9.1%, and in patients with metastatic disease of 7.8%. Survival in patients resuscitated on the general medical/surgical wards was 10.1%, while survival in patients resuscitated on intensive care units (ICUs) was 2.2%.

CONCLUSIONS

Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.

Nurses and health support workers' views on cardiopulmonary resuscitation in a hospice setting

This paper reports on a study which took place in a 15-bed hospice and provides an account of the views of registered nurses (n = 12) and health support workers (n = 10) in relation to cardiopulmonary resuscitation (CPR) within a hospice setting. The study was part of a larger ethnographic research project being conducted in the hospice when the British Medical Association/Royal College of Nursing and the Resuscitation Council UK (Resuscitation Council UK, 2001) published guidelines urging all establishments that face decisions about attempting CPR to develop local policies. The guidelines provided the impetus for the present study, the aim of which was to explore staff responses to the introduction of a CPR policy in the hospice. Semi-structured interviews were conducted on a purposive sample of hospice staff. The findings raise issues about the implementation of CPR in a context where it was felt that the patient should be allowed to die a natural death.