Whilst discussing the prognosis with the patient and family, it may also be appropriate to have discussions about decisions regarding cardiopulmonary resuscitation. The health care professional should establish the communication needs and expectations of the patient, taking into account if they would like a person important to them to be present and involved.
It is difficult to decide when is the most appropriate moment to discuss this sensitive matter, but in general patients and their relatives appreciate involvement at an earlier rather than later. Explain uncertainty but avoid false optimism. Explore whether they have an advance statement or stated preferences about their care, their views on allowing natural death and decisions about cardiopulmonary resuscitation.
The GMC advises in their Treatment and care towards the end of life guidance that:
'You must make it clear to the healthcare team and, if appropriate, the patient and those close to the patient that a DNACPR decision applies only to CPR. It does not imply that other treatments will be withdrawn or withheld.' (Source: GMC)
There is currently no nationally available DNACPR form, although the Resuscitation Council (UK) provides a template and there is a unified form available in Scotland.
In some areas, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form may be available. The ReSPECT form is much broader that a DNACPR form, and records recommendations to guide immediate decision-making about a person’s care and treatment in a future emergency situation where they lack capacity. This includes a recommendation as to whether CPR should be attempted or not. Further information is available at www.respectprocess.org.uk.
The BMA has published joint guidance with the Resuscitation Council and Royal College of Nursing, Decisions relating to cardiopulmonary resuscitation, most recently updated in 2016 to add greater emphasis on ensuring high-quality timely communication, decision-making and recording in relation to decisions about CPR.