Abstract

Background

Cancer patients admitted acutely to hospital are more likely to suffer from cardiac arrest, and less likely to survive, than general inpatients. As such, it is of great importance to consider the appropriateness of cardiopulmonary resuscitation and escalation of care in this patient group. This should be discussed sensitively with patients and their relatives at the earliest opportunity. This audit sought to map current practice regarding discussions around resuscitation across England and Scotland in patients with cancer admitted acutely to hospital.

Method

A cross-sectional, multi-centre audit of practice undertaken by collaborators from the Macmillan medical student network. Participants were adult patients admitted acutely to an oncology ward or reviewed by an acute oncology service within 24 hours of admission. 251 patient encounters were identified across eight hospitals in England and Scotland to identify whether a discussion regarding resuscitation was documented as having taken place during an inpatient admission. As an audit standard it was expected that all patients should be invited to discuss resuscitation within 24 hours of admission.

Results

A discussion regarding resuscitation was had in 31.5% of admissions and of these 72.0% were within 24 hours; 22.7% of all admissions. 7.2% of patients had a ‘do not attempt resuscitation’ order prior to admission with no significant difference between patients receiving treatment with palliative or curative intent (9.1% and 2.7% respectively, p=0.12). Discussions regarding escalation of care took place in only 15.9% of admissions.

Conclusion

This study provides compelling data that highlights deficiencies in the number of discussions regarding resuscitation that are being conducted with cancer patients that become acutely unwell. It also demonstrates the value of a medical student collaborative in rapidly collecting national audit data.