Experience Summary

In this experience, watch as a consultant undertakes a discussion regarding a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order.

The patient has been admitted with a pneumonia, and although she has been given antibiotics and oxygen, she is not significantly improving. The consultant in charge of her care has therefore decided to initiate discussions surrounding resuscitation and care planning.

Clinical Context

Conversations about a DNACPR order are an important aspect of patient-centred care and advance care planning. These discussions can be emotionally challenging for patients, families, and healthcare professionals, but they are essential to ensure that decisions about cardiopulmonary resuscitation (CPR) reflect the patient's clinical circumstances, values, and preferences. Effective communication enables patients to make informed decisions and helps ensure that care remains focused on achieving the best possible quality of life.

DNACPR discussions should take place in a timely, sensitive, and honest manner, allowing sufficient time for patients to ask questions and express their concerns. Clinicians should explain what CPR involves, including its potential benefits, limitations, and likelihood of success based on the individual's medical condition. It is important to clarify that a DNACPR decision relates only to CPR and does not mean that other treatments, symptom management, or appropriate medical care will be withheld. This distinction can help reduce anxiety and address common misconceptions surrounding DNACPR decisions.
Healthcare professionals should explore the patient's understanding of their illness, identify what matters most to them, and encourage shared decision-making wherever possible. Family members or those close to the patient may be involved in discussions with the patient's consent or, where the patient lacks capacity, in accordance with relevant legal and ethical frameworks. Decisions should be clearly documented, communicated to the wider multidisciplinary team, and reviewed regularly, particularly if the patient's condition or wishes change.
High-quality DNACPR conversations require empathy, active listening, and respect for patient autonomy. By approaching these discussions with compassion and clarity, clinicians can support informed decision-making, minimise misunderstandings, and ensure that resuscitation decisions align with the patient's goals of care and best interests. Effective communication surrounding DNACPR decisions contributes to high-quality end-of-life care while promoting dignity, trust, and person-centred clinical practice.

Reflection Points

How did the doctor address the patient’s concerns?

Is there anything you would have done differently to the doctor in this experience?

How did explain what the DNACPR order means?

Learning Outcomes

1. Understand what the purpose and meaning of a DNACPR order is.
2. Understand the legalities of a DNACPR order.
3. Observe a discussion about a DNACPR order with a patient.

External Resources

• Decisions relating to cardiopulmonary resuscitation - Guidance from the British Medical Association, Resuscitation Council UK, and the Royal College of Nursing
• Patient information leaflet on Decisions about Cardiopulmonary Resuscitation (CPR) - Resuscitation Council UK