Research and Evaluation Manager
When it reaches the critical point when families and carers have to make difficult decisions about a loved one’s end-of-life care, it’s sometimes the first they have heard about the medical decision known as ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR). Distressed with worry and concern for their loved one, they might not even take on what it all really means. Is not resuscitating the right decision? Should they let their loved one die with dignity? Could they have been saved?
Most people have seen CPR on TV and in films. 9 times out of 10 it seems to work and the fallen hero is rescued from the brink of death. Very sadly, the real-life survival rates from CPR are very different – only about 12% of people survive CPR out-of-hospital cardiac arrests.
Doctors’ experiences of talking about DNACPR
We recently carried out a survey to find out about doctors’ experiences of making and communicating DNACPR decisions. Over 700 healthcare professionals shared their views with us about:
- their experience of how DNACPRs are applied
- how well they thought the DNACPR process was managed
- guidance for managing DNACPR decisions.
Through this survey, doctors told us that they sometimes shy away from discussing end-of-life care with individuals. This can be due to a lack of time within a stretched service but can also be because they lack the confidence to hold these discussions. These are difficult conversations at the end of a patient’s life and, as a society, we are not known for talking about our own mortality.
We also heard accounts of CPR being provided when it was already known it would not be in the patient’s best interest. The fear of litigation from family members, who perceive that a DNACPR equates to a withdrawal of care for their loved one, was a factor here.
Many respondents believed there were many myths about DNACPR, fuelled in part by the way it’s reported by the media. This has led some patients and next of kin to overestimate its effectiveness and success rate, while underestimating the complications and negative effects it can have.
Cultural factors also play a part here. Our reluctance as a society to readily discuss issues relating to death and mortality can be an additional barrier to reasoned and informed discussions about DNACPR. We need to take a fresh look at how clinicians are trained to sensitively broach these discussions.
Towards a more compassionate approach to end-of-life care
Our research reveals that the greatest barrier to managing discussions and decisions about DNACPR is the public’s perception of it.
87% of the doctors we surveyed said that greater awareness among the public about why DNACPR notices are applied would go some way to addressing these issues.
Along with other measures, this would help pave the way towards a more compassionate and appropriate approach to end-of-life care. It would allow patients and next-of-kin the time and information they need to fully consider their decisions and focus on allowing a dignified, natural death.
To find out more about this research, please read our report on the survey findings [PDF 707KB].
Recommendations for improving conversations about end-of-life care
We carried out this research as part of a wider project exploring conversations about decisions on end-of-life care and DNACPR. As part of this project we also:
- heard from families, carers and patients
- heard from frontline staff and professionals working in health and social care policy
- analysed evidence from our casework.
Our findings and recommendations to improve communication about the use of DNACPR are published in our report ‘End-of-life care: improving ‘do not attempt CPR’ conversations for everyone’.
