Background Current policy emphasises the importance of including palliative and end of life patients and their families in decisions about their care (House of Commons Health Committee, 2015; National Institute for Health and Care Excellence, 2017) with clear, sensitive and timely communication (Leadership Alliance for the Care of Dying People, 2014; National Palliative and End of Life Care Partnership, 2015). Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) conversations can help patients accept their predicament (Low et al., 2014) and may help to achieve a dignified death (Mack et al., 2012). However, there is little research detailing how these conversations take place or the terminology and approaches used.

Aims This research study explored the experiences of Clinical Nurse Specialists (CNSs) in palliative care when managing Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) conversations with patients and their families.

Methodology Six semi-structured interviews were conducted in a hospice setting. The results were presented using an autoethnographic approach, exploring the author’s experiences in addition to those of colleagues (CNSs) selected by purposive sampling. Data was analysed using NVivo11 applying thematic analysis.

Results Four main themes emerged; learning from experiences, feeling responsible to get it right, how conversations are initiated and the barriers to DNACPR discussions. DNACPR conversations are particularly difficult where patients and families are informed inappropriately or insensitively about DNACPR and when there is little rapport established. CNSs are challenged in balancing sensitivity whilst also communicating clearly about key decisions that are essential to supporting a dignified death.

Conclusion Fears associated with communicating DNACPR decisions may lead to patients receiving information inappropriately, insensitively and without clarity. Raising awareness of these research findings amongst healthcare professionals can lead to enhanced communication provided in a clear, timely and sensitive manner by a healthcare professional with whom patients have an existing rapport.