Doctors Need Training on DNACPR Discussions: Study

Dawn O'Shea

July 26, 2021

Hospital doctors need more training in conversations around ‘Do not attempt cardiopulmonary resuscitation' (DNACPR) decisions, and guidance from senior doctors could be valuable, according to a survey of medical staff working in acute wards.

The survey was distributed to 200 doctors working on the acute medical rota at Oxford University Hospitals NHS Foundation Trust between 2 August 2017 and 31 July 2018. All responses were anonymous and the findings were published in BMJ Supportive & Palliative Care.

The survey questions included items about the doctor’s personal and professional characteristics, whether they had received specific training in DNACPR discussions and how many of these discussions they had in a typical week.

Doctors were asked to rate how difficult they found having these discussions with older inpatients and their families - easy, fairly easy, fairly difficult or difficult. They were also asked to rate how frequently (never, sometimes, often or always) the following issues were causes of difficulty:

  • Not having a suitable place to have the discussion,

  • Not having enough time to have the discussion,

  • Being unsure about the patient’s prognosis,

  • Being unsure about the chances of resuscitation being successful, and

  • Being unsure about what to say.

A total of 171 (86%) of eligible doctors participated, of whom 165 had experience of DNACPR discussions with older inpatients and/or their families and were included in the analysis.

Fifty-two participants said they had difficulty (fairly difficult or difficult) having these conversations with patients and 60 said they had difficulty speaking to the patient’s family about DNACPR decisions.

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.

"Our findings have implications for how we train and support doctors with DNACPR discussions," the authors said.

First, we need to ensure that doctors receive specific training in this important part of their job. Second, we need training that includes how to have DNACPR discussions with families and how to manage prognostic uncertainty. Third, we should recognise the value of experience and seniority. Finally, we should ensure that doctors have both the time and a suitable place to have DNACPR discussions."

In March, the Care Quality Commission (CQC) has expressed "serious concerns" that individuals' human rights may have been breached in more than 500 cases where do not attempt cardiopulmonary resuscitation (DNACPR) decisions were made during the pandemic.

Walker J, Burke K, Magill N, van Niekerk M, Wanat M, Hobbs H, Rocroi I, Frost C, Sharpe M. 'Do not attempt cardiopulmonary resuscitation' (DNACPR)-difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors. BMJ Support Palliat Care. 2021 Jul 14 [Epub ahead of print]. doi: 10.1136/bmjspcare-2021-003151. PMID: 34261766

This article was adapted from Univadis, part of the Medscape Professional Network.

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