Barriers and facilitators for cardiopulmonary resuscitation discussions with people with heart failure

Background Care planning with people with advanced heart failure enables appropriate care, and prevents futile interventions, such as cardio-pulmonary resuscitation (CPR). Aim To explore what motivates clinicians to conduct, and people with heart failure and their carers, to engage in well-conducted CPR discussions. Methods In-depth remote interviews with i) people with heart failure and self-reported daily symptoms (>= 3 months), ii) informal carers and, iii) clinicians recruited through social media and professional groups, team contacts and snowballing. Interviews were audio-recorded, transcribed, anonymised and subjected to framework analysis. Findings were mapped to the Capabilities, Opportunities, Motivation-Behaviour change model. Results Two themes were generated from 23 interviews: a) the cardio-pulmonary resuscitation discussion: preparation; who should conduct discussions; what should happen during discussions; impact on future discussions; b) Understanding of the: patient's health status; and purpose and likely outcome of cardio-pulmonary resuscitation. For clinicians, ensuring preparation time, education, and support provided physical and psychological capability. For all, constructive experiences and a realistic understanding of health status and likely cardio-pulmonary resuscitation outcome motivated engagement in cardio-pulmonary resuscitation discussions providing opportunity for patient involvement in decision-making. Conclusions For all, constructive past experiences of important conversations motivates engagement with CPR discussions. A realistic understanding of health status and likely cardio-pulmonary resuscitation outcome (all stakeholders), and training, skills, preparation and multidisciplinary support (clinicians) provide physical and psychological capability. Findings should inform organisational structures and training to ensure opportunity for this important clinical practice to take place.