Palliative care staff's perceptions of do not attempt cardiopulmonary resuscitation discussions

Background: Do not attempt cardiopulmonary resuscitation (DNACPR) decisions aim to prevent unwanted and/or clinically inappropriate CPR attempts. As the NHS Scotland DNACPR policy has become embedded into clinical practice there has been greater awareness of the need to discuss DNACPR decisions with patients who would not benefit from CPR; however, little is known about how nursing and medical staff experience these discussions.

Aim: This study aimed to explore clinician experiences of discussing DNACPR decisions with patients in a Scottish specialist palliative care inpatient and community setting.

Method: Semi-structured face-to-face interviews were held with I I specialist palliative care clinicians. These were transcribed and thematic analysis was undertaken.

Results: The clinicians found DNACPR discussions challenging and experienced anxiety before discussions took place. They found it most appropriate to discuss DNACPR in the context of wider end-of-life discussions and in response to patient triggers. Patient-clinician relationships were complex and could make the conversation easier or more difficult. Negative patient reactions were rare and discussions were thought to provide some patients with a sense of relief.

Conclusion: The clinicians reported finding DNACPR discussions worthwhile and that they continue to discuss DNACPR decisions with patients despite the challenges. Recommendations for discussing DNACPR with patients arc outlined.