DNACPR - Counselling a relative
Professionalism
SimulationUse this resource in conjunction with your real-world training
Experience Summary
In this experience, watch a discussing surrounding resuscitation.
Johnathan is an elderly gentleman who has been admitted to the Intensive Care Unit (ICU) following a significant bowel operation. Watch as an ICU Consultant discusses the implementation of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order with Johnathan’s Son Brian.
Clinical Context
Conversations with a patient's relative about cardiopulmonary resuscitation (CPR) are often among the most sensitive and challenging discussions in clinical practice. They require clear communication, empathy, and an understanding of the emotional impact that discussions about deterioration and end-of-life care can have on families. The aim is to ensure that relatives understand the patient's condition, the role of CPR, and the reasons why it may or may not be clinically appropriate, while providing them with the opportunity to ask questions and express their concerns.
During these discussions, clinicians should explain what CPR involves, including the procedures used, the potential risks, and the likelihood of success in the context of the patient's current health and underlying illness. It is important to communicate that CPR is not always beneficial and, in some situations, may prolong suffering without providing meaningful recovery. Relatives should also be reassured that decisions about CPR relate only to whether resuscitation would be attempted following a cardiac or respiratory arrest and do not affect other aspects of treatment, symptom management, comfort measures, or ongoing medical care. Where the patient has capacity, decisions about CPR are made with the patient, and relatives can only be involved with the patient's agreement. If the patient lacks capacity, relatives or those close to the patient play an important role in helping the clinical team understand the patient's previously expressed wishes, values, beliefs, and preferences. While relatives are not responsible for making the CPR decision, their input helps clinicians determine what would be in the patient's best interests.
Compassionate communication, active listening, and allowing time for questions are essential throughout these conversations. By approaching discussions with honesty, sensitivity, and respect, healthcare professionals can support relatives during a difficult time, reduce misunderstandings, and ensure that decisions about CPR are made transparently and in accordance with the patient's wishes, clinical circumstances, and relevant legal and ethical guidance.
Reflection Points
How did the doctor address the relative’s concerns?
Is there anything you would have done differently to the doctor in this experience?
How did the doctor explain what the DNACPR order means?
Learning Outcomes
- Understand what the purpose and meaning of a DNACPR order is.
- Understand the legalities of a DNACPR order.
- Observe a discussion about a DNACPR order with a patient’s relative.
External Resources