{"id":1623,"date":"2021-03-08T16:38:51","date_gmt":"2021-03-08T16:38:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=1623"},"modified":"2021-03-10T12:39:05","modified_gmt":"2021-03-10T12:39:05","slug":"dont-judge-the-book-by-its-cover-clinicians-and-charities-speak-out-about-the-positive-role-dnacpr-conversations-can-play-in-providing-good-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2021\/03\/08\/dont-judge-the-book-by-its-cover-clinicians-and-charities-speak-out-about-the-positive-role-dnacpr-conversations-can-play-in-providing-good-care\/","title":{"rendered":"‘Don’t judge the book by its cover’- Clinicians and charities speak out about the positive role\u00a0DNACPR conversations can play in providing\u00a0good care"},"content":{"rendered":"

Authors:<\/strong><\/em><\/p>\n

Dr Linda Dykes, Consultant in Emergency and Interface Frailty Medicine<\/strong><\/em><\/p>\n

Professor Mark Taubert, Palliative Medicine Consultant\u00a0<\/strong><\/em><\/p>\n

Usha Grieve, Director of Partnerships and Services, Compassion in Dying, United Kingdom<\/strong><\/em><\/p>\n

\"\"<\/a><\/p>\n

This article and its accompanying joint statement links to a news report in the Independent\u00a0<\/a><\/em><\/p>\n

The Covid-19 pandemic has brought Do Not Attempt Cardiopulmonary Resuscitation<\/strong> (DNACPR) decisions into the public consciousness like never before. Pressures on the healthcare system and individual clinicians have exposed long-standing problems with the way these decisions are communicated and made.<\/p>\n

Reports of blanket decision-making, where decisions about CPR are made on the basis of characteristics such as age or whether a person has a learning disability, are completely unacceptable (and unlawful). The impact that this and poor communication has on patients and family members is huge. It causes significant distress and, importantly, risks eroding trust between people and their doctors.<\/p>\n

However, DNACPR decisions – when done well, and communicated in a timely and sensitive way – can play an essential part in making a person\u2019s end-of-life experience a good one. It is vital that everyone working in health and care collaborates to learn from the lessons of the pandemic. Just as importantly, we must work to build public trust and understanding of the role DNACPR decisions play in providing high-quality, personalised care.<\/p>\n

This week, 38 healthcare professionals, campaigners and charities, including Marie Curie, Sue Ryder, Resuscitation Council UK and Hospice UK, have come together to assert the importance of good communication and DNACPR decision-making and commit to learning from the experiences of the people impacted by poor practice. Published by Shaun Lintern in the Independent, the joint statement and signatories can be read in full below. The statement comes ahead of a review into DNACPR practice during the pandemic, which is due to be published later this month,<\/p>\n

All of us will die one day, and CPR was designed to treat otherwise healthy people whose hearts have suddenly stopped: CPR is not, and never will be, a treatment for \u201cordinary dying\u201d.<\/p>\n

The reality is that CPR usually fails, and is often a brutal and invasive procedure that can leave survivors with side effects such as broken ribs or brain damage. CPR rarely returns people to the quality of life they had before their heart or breathing stopped, and the chance of success is particularly low in people with serious pre-existing health problems, or those who have reached a great age.<\/p>\n

Having clear instructions and DNACPR decisions in place can protect people from an intervention which could be harmful and\/or unwanted. DNACPR decisions are about valuing people\u2019s lives, and their wishes: whilst in the UK, nobody can demand CPR against medical advice, many people appreciate the chance to firmly refuse CPR \u2013 including some whose medical status would suggest a CPR attempt would possibly succeed. They can help to ensure people\u2019s dignity and choices are respected right to the end.<\/p>\n

Importantly, the existence of DNACPR decisions means that families are not left worrying about having difficult conversations in stressful circumstances about their loved one\u2019s treatment. Exposure to Hollywood movies and social media discussions has been known to cause confusion for British families who often do not realise that, in this country, decisions about DNACPR are not their \u201cburden to bear\u201d \u2013 they are medical decisions, but must be discussed with patients (or their family if they cannot have a conversation themselves). \u00a0What\u2019s more, we know that many people want the protection and reassurance of a DNACPR decision.<\/p>\n

\u201cI am fully aware of the negative effects of over-treatment at the end of life, however well-intentioned. I requested the DNACPR form because I have ovarian cancer and it would be utterly pointless (not to mention unnecessarily traumatic) to be put through a futile attempt at CPR.\u201d<\/em> (Caller to Compassion in Dying\u2019s Information Line)<\/p>\n

As we move through and beyond the pandemic, it is crucial that clinicians feel confident and supported to have conversations with their patients and reach a shared understanding about CPR decisions and what matters to that individual. If we don\u2019t talk about it, we risk denying people of their wishes.<\/p>\n

Joint Statement in full:<\/strong><\/em><\/h2>\n

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussions and decisions are a valuable and essential part of end-of-life care.<\/em><\/p>\n

They enable people to refuse cardiopulmonary resuscitation (CPR) in the event their heart stops, and they enable clinicians to make timely and informed decisions about when the highly invasive and often futile procedure of CPR would do more harm than good. Not everyone wants CPR to be attempted, so for many people, DNACPR decisions offer reassurance that they will not be given a treatment that may be unwanted or unsuccessful.<\/em><\/p>\n

For many, the pandemic has for the first time revealed the nature of caring for dying people and the realities of clinical decision-making. It is hoped that increasing people\u2019s readiness to discuss death and dying will be one positive legacy of this pandemic, amid the devastation it has caused.<\/em><\/p>\n

It also provides an important opportunity for learning and improvement. There have been examples of poor practice in relation to DNACPR decision-making during the pandemic, and the distressing impact this has had on patients and families cannot be underestimated. It is essential to thoroughly understand and learn from these cases to ensure that they do not happen again. To this end, we welcome the Care Quality Commission\u2019s review into DNACPR decisions, due to be published in the coming weeks.<\/em><\/p>\n

We are aware that the benefits of DNACPR decisions can be easily undone if they are not accompanied by honest, open and sensitive communication with a person\u2019s healthcare team. To ensure that everybody who encounters a DNACPR discussion has a positive experience, we need to do more to listen to individuals and their families; their wishes must be sought and documented, their questions answered and their feelings acknowledged. A DNACPR decision must always involve the person, or those close to them, and should be part of a wider conversation about what matters to that individual.<\/em><\/p>\n

A society that values its citizens is one that seeks to avoid inflicting unnecessary harm on them. Good decision-making and proactive conversations involving people and their families help to achieve this. DNACPR decisions are, for some, a vital part of this process. We encourage clinicians, charities, professional bodies, the media and Government to ensure that this message is heard loud and clear.<\/em><\/p>\n

\u00a0<\/em><\/p>\n

Contributors:<\/em><\/p>\n

Professor Emeritus Sam Ahmedzai, Retired Palliative Medicine Specialist<\/em><\/p>\n

Dr Anushka Aubeelack, Intensive Care Anaesthetist<\/em><\/p>\n

Dr Arun Bhaskar, President, British Pain Society\u00a0 <\/em><\/p>\n

Compassion in Dying<\/em><\/p>\n

Dr Joe Cosgrove, Chair of End of Life Working Group (2017-19), Faculty of Intensive Care Medicine<\/em><\/p>\n

Dr Chris Danbury, Consultant Intensive Care Physician<\/em><\/p>\n

Dr Linda Dykes, Consultant in Emergency and Interface Frailty Medicine<\/em><\/p>\n

Professor Aneez\u00a0Esmail, GP and Professor of General Practice<\/em><\/p>\n

Lorraine Foley, CEO, Professional Record Standards Body<\/em><\/p>\n

Dr Rohin Francis, Cardiologist<\/em><\/p>\n

Clare Fuller, Registered Nurse and Director of Speak for Me LPA<\/a><\/em><\/p>\n

Dr Dawn Harper, GP and Broadcaster<\/em><\/p>\n

Moira Hill, End of Life Coach and Registered Nurse (1989 – 2016)\u00a0 <\/em><\/p>\n

Hospice UK<\/em><\/p>\n

Dr Sarah Jarvis, GP and Broadcaster<\/em><\/p>\n

Professor\u00a0Celia Kitzinger, Coma and Disorders of Consciousness Research Centre<\/em><\/p>\n

Professor Jenny Kitzinger,\u00a0 Coma and Disorders of Consciousness Research Centre<\/em><\/p>\n

Dr Diane Laverty, Macmillan Nurse Consultant in Palliative Care<\/em><\/p>\n

Professor Alison Leary, Registered Nurse and Chair of Healthcare & Workforce\u00a0Modelling, London Southbank University<\/em><\/p>\n

Dr Rosemary Leonard, GP and Broadcaster<\/em><\/p>\n

Dr Kathryn Mannix, Retired Palliative Medicine Consultant and Author <\/em><\/p>\n

Marie Curie<\/em><\/p>\n

Kate Masters, Campaigner and Family Member with Lived Experience of End-of-Life Decision-Making<\/em><\/p>\n

Dame Barbara Monroe, Former Hospice CEO<\/em><\/p>\n

Dr Matt Morgan, Intensive Care Consultant<\/em><\/p>\n

Professor Adrian Newland, Past President, Royal College of Pathologists<\/em><\/p>\n

Dr David Nicholl, Consultant Neurologist<\/em><\/p>\n

Dr Zoe Norris, GP<\/em><\/p>\n

Dr Liz O’Riordan, Retired Breast Surgeon, Author and Broadcaster<\/em><\/p>\n

Resuscitation Council UK<\/em><\/p>\n

Professor Julia Riley, Palliative Care Consultant<\/em><\/p>\n

Ken Spearpoint, Principal Lecturer in Medical Education & Former Consultant Nurse in Resuscitation<\/em><\/p>\n

Sue Ryder<\/em><\/p>\n

Professor Raymond Tallis, Retired Geriatrician, Neuroscientist and Philosopher<\/em><\/p>\n

Professor\u00a0Mark Taubert, Palliative Medicine Consultant\u00a0<\/em><\/p>\n

Dr Paul Teed, Emergency Medicine Physician<\/em><\/p>\n

Dr Dan Thomas, Consultant Geriatrician<\/em><\/p>\n

Professor Sue Wilkinson, Chair, Advance Decisions Assistance<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Authors: Dr Linda Dykes, Consultant in Emergency and Interface Frailty Medicine Professor Mark Taubert, Palliative Medicine Consultant\u00a0 Usha Grieve, Director of Partnerships and Services, Compassion in Dying, United Kingdom This article and its accompanying joint statement links to a news report in the Independent\u00a0 The Covid-19 pandemic has brought Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":246,"featured_media":1624,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1979],"tags":[],"class_list":["post-1623","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-social-media"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts\/1623","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/users\/246"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/comments?post=1623"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts\/1623\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/media\/1624"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/media?parent=1623"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/categories?post=1623"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/tags?post=1623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}