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‘Do not attempt cardiopulmonary resuscitation’ (DNACPR)—difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors
  1. Jane Walker1,
  2. Katy Burke2,
  3. Nicholas Magill3,
  4. Maike van Niekerk1,
  5. Marta Wanat4,
  6. Harriet Hobbs1,
  7. Isabelle Rocroi1,
  8. Chris Frost3 and
  9. Michael Sharpe1
  1. 1Psychological Medicine Research, University of Oxford Department of Psychiatry, Oxford, UK
  2. 2University College London Hospitals NHS Foundation Trust Palliative Care Team, London, UK
  3. 3Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jane Walker, Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK; jane.walker{at}psych.ox.ac.uk

Abstract

Objectives To determine, for doctors looking after older medical inpatients: (1) how difficult they find discussions about ‘do not attempt cardiopulmonary resuscitation’ (DNACPR); (2) whether difficulty is associated with doctors’ personal and professional characteristics; (3) how frequently DNACPR discussions are made more difficult by practical issues and by doctors’ uncertainties.

Methods Survey of hospital doctors working on the acute medical wards of a UK NHS teaching hospital.

Results 171/200 (86%) of eligible doctors participated. 165 had experience of DNACPR discussions with older inpatients and/or their families and were included in our analysis. ‘Difficulty’ (defined as finding discussions ‘fairly difficult’ or ‘difficult’) was experienced by 52/165 (32%) for discussions with patients and 60/165 (36%) for discussions with families. Doctors with specific training in DNACPR discussions were less likely to have difficulty in discussions with patients. Older, more experienced doctors were less likely to have difficulty in discussions with families. Lack of time and place, and uncertainty about prognosis were the most frequently reported causes of difficulty.

Conclusions Many doctors have difficulty in DNACPR discussions. Training needs to include managing discussions with families, as well as with patients, and doctors need time and space to deliver this important part of their job.

  • Clinical decisions
  • Communication
  • End of life care
  • Family management
  • Hospital care

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Footnotes

  • Contributors JW, MS, KB, MvN and MW designed the study. CF and NM conducted the analysis. JW drafted the paper. All authors contributed to writing and reviewing the paper.

  • Funding This study was funded by the UK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care at Oxford Health NHS Foundation Trust, Oxford, UK.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no involvement in study design; collection, analysis and interpretation of data; writing of the report; or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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