End of life decisions evidence report

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Clinicians providing end of life care to a patient need to be aware of their wishes, goals and values.

One important component in planning for quality end of life care is documenting a resuscitation plan. A resuscitation plan is a medically authorised order to use or withhold resuscitation measures and document other time critical clinical decisions related to end of life.

Resuscitation planning in NSW Public Health Organisations follows the NSW Policy Directive: Using Resuscitation Plans in End of Life Decisions (PD2014_030).

This End of Life Decisions: Evidence Report summarises local experiences and insights in goals of care and resuscitation conversations and plans from various perspectives in NSW and outlines the international evidence.

This will inform statewide improvements to the policy directive.

Key findings

  • In the 2022 calendar year, there were 24,427 in-hospital patient deaths in NSW public hospitals with a death screen completed in the CEC Death Review Database. Of these patients, 15,216 (62.3%) had a resuscitation plan documented.
  • The content or format of the resuscitation plan is less important than the way information is communicated, the transparency of decisions and shared mutual understanding between treating clinicians, patients, families and carers.
  • Resuscitation planning conversations can be confronting, overwhelming and distressing for health professionals and consumers.
  • Health professionals as well as consumers can feel reluctant to discuss goals of care and/or resuscitation planning.
  • Positive experiences occur when conversations between consumers and healthcare professionals are two-way.
  • Perceived barriers to having resuscitation planning conversations included:
    • lack of community awareness and understanding of end of life care
    • lack of standardised documentation and limited integration and functionality of the plan across care settings
    • difficulties navigating different cultural, moral, spiritual and ethical preferences.
  • Perceived enablers to having resuscitation planning conversations included:
    • multidisciplinary team collaboration
    • use of standardised documentation across care settings
    • access to a role model to coach and mentor staff in having difficult conversations.

Report

Appendices

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