RT Journal Article
SR Electronic
T1 ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR)—difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP bmjspcare-2021-003151
DO 10.1136/bmjspcare-2021-003151
A1 Jane Walker
A1 Katy Burke
A1 Nicholas Magill
A1 Maike van Niekerk
A1 Marta Wanat
A1 Harriet Hobbs
A1 Isabelle Rocroi
A1 Chris Frost
A1 Michael Sharpe
YR 2021
UL http://spcare.bmj.com/content/early/2021/07/14/bmjspcare-2021-003151.abstract
AB 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.