Resuscitation evidence shows need for end of life care communications training

Categories: Education.

Recent media coverage has highlighted the need for healthcare professionals who work with people approaching the end of life to properly discuss Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions with patients and their families.

Findings from the Royal College of Physicians’ latest national care of the dying in hospital audit found that, in a review of 9,000 patient case notes in England, 36% noted that a senior doctor had discussed CPR with the patient.

Discussions were more likely to have taken place with a nominated person close to the patient (81%), which is an improvement on the 2013 figure. However, in 16% of cases there was no reason why a discussion did not take place.

Difficult but necessary conversations

The audit cannot tell us exactly why these discussions didn’t happen, but it shows there is still a skills gap when it comes to end of life care conversations.

We know that some healthcare professionals report finding it difficult to discuss DNACPR and the dying process with their patients, which means these necessary conversations are missed out or carried out poorly.

Marie Curie continues to call for healthcare professionals to have the training and confidence to broach the subject of DNACPR, and end of life care more generally.

This is a crucial step towards ensuring that patients and those important to them have the opportunity to express their wishes and make informed choices.

As people live longer, they often develop more complex needs, and the number of people dying is predicted to increase year upon year. Unless efforts are made to ensure meaningful conversations about DNACPR and advance care planning become routine, more people will face the end of life without having the chance to express their wishes on such important aspects of care.

When might a DNACPR decision be appropriate?

Cardiopulmonary Resuscitation (CPR) is a technique which involves restarting the heart when it has stopped. It is quite an invasive procedure and, even when successful, may result in side effects such as injury to organs.

DNACPR decisions are made to prevent the distress caused by performing inappropriate CPR attempts. For someone with a terminal illness, this might be because it is felt that CPR would not work or cause unnecessary suffering when they are approaching the end of their life. Making decisions about whether to attempt CPR can be part of advance care planning.

How should a DNACPR decision be made?

Following a ruling by the Court of Appeal in 2014, all NHS Trusts in England have a legal duty to consult with and inform patients with mental capacity if a DNACPR order is placed on their records.

This triggered new UK-wide guidance, which emphasises that anticipatory decisions about CPR are good clinical practice and, whenever possible, should be made well in advance, when people are well enough and have enough time to consider them carefully and discuss them fully with anyone that they wish to, including their family and their healthcare team.

Regardless of their condition, age or where they live, people who have a terminal illness and those close to them should therefore expect to receive support from suitably trained professionals to have these important conversations.

There is more information about planning care in advance on the Marie Curie website.

Leave a Reply

Your email address will not be published. Required fields are marked *