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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

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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