Summary
A change in how British people and health professionals talk about death is needed to avoid delays in crucial conversations about end-of-life care, resulting in traumatic consequences for patients and their families, the Parliamentary and Health Service Ombudsman (PHSO) has warned.
In a new report, End of life care: improving ‘do not attempt CPR’ conversations for everyone, PHSO has called for urgent improvements to the process and communication surrounding do not attempt cardiopulmonary resuscitation (DNACPR), so doctors, patients, and their loved ones can make informed choices about their care.
Content
A DNACPR notice means if someone’s heart or breathing stops, doctors will not attempt resuscitation. The decision is made by a doctor and does not actually require patient consent, but legally a patient must be informed if they have capacity, or their next of kin otherwise.
The majority of complaints received about the communication of DNACPR notices by PHSO during the Covid-19 pandemic were either from older people or disabled people, or on their behalf.
Although DNACPR discussions are positive when done in the right way, it is clear this is not always happening and improvements to the discussion process needed. The report found end of life conversations often happen in emergency settings, which is often too late and carried out under extreme stress. Conversations are also left to a patient’s family, and in some instances a patient was left out of the conversation entirely. In some cases, doctors breached people’s human rights by not even informing them or their family that a DNCAPR notice was made.
Key findings include:
- a lack of accessible information given at the time or before DNACPR conversations take place
- issues with record-keeping and documenting decisions, with up-to-date information not following a patient through the medical system
- a lack of public awareness about CPR and who is responsible for making a DNACPR decision.
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