End-of-life care: improving 'do not attempt CPR' conversations for everyone

The government has since recognised the impact of visitation restrictions and changed the law to allow visitation as part of care in future crises (Department of Health and Social Care, ‘Government to legally make visiting a part of care’). [...] The court said there should be a presumption in favour of patient involvement in DNACPR decisions: “The duty to consult involves a discussion, where practicable, about the patient’s wishes and feelings that is better undertaken at the earliest stage of the clinical relationship so that decisions can be reviewed as circumstances change…the duty to consult is integral to the respect for the dignity. [...] While all the nurses we spoke with felt they would be able to challenge a poor DNACPR decision, they acknowledged that this is unlikely to be the case for more junior healthcare staff, some of whom are likely to have closer relationships to the patient involved in the decision. [...] The form should be seen as similar to operative consent and use that model.” Survey response of doctor working in acute internal medicine “There is not enough space on the form to write much detail about the conversations that happen, the clinical conditions that lead to the DNACPR decision or much free text space.” Survey response of doctor working in general practice This lack of space particula. [...] The training should have clear learning outcomes, covering: • the legal requirement to communicate a DNACPR decision to the person (or someone close to them if they lack capacity to engage in a conversation about DNACPR) unless it is likely to cause the person harm • communicating the decision using a human rights-led approach • what is meant by appropriate documentation of DNACPR conversations an.