Communication
CPSA · Communication · Sharing difficult news
Discussing DNACPR and ceilings of care
A clinical decision about ONE intervention, but one that must be discussed — failing to consult was unlawful in *Tracey*. The commonest error is letting the patient believe it means abandonment.
The framework
Prepare
- Know the clinical position: would CPR work, and what would survival look like? You cannot have the conversation without an answer.
- Private space, sit down, offer to have family present if the patient wants them.
Explore first
- What do they understand about their illness and where it is heading?
- What matters to them — being at home, staying independent, avoiding hospital, seeing someone in particular?
Explain
- Describe what CPR actually involves and, honestly, how likely it is to work for them.
- State clearly that this is about ONE treatment, and that everything else continues.
Decide and document
- It is a clinical recommendation, not a request for consent — but it must be explained, and disagreement escalated to a senior.
- Record the discussion, who was present, and the reasoning. Complete ReSPECT where used.
Phrases that work
- “Can I check what you understand about how things are at the moment?”
- “If your heart were to stop, attempting to restart it would not work — and it would mean a very undignified death. So I am recommending we do not attempt it.”
- “This changes nothing else. We will still treat infections, still give fluids, still treat your pain — everything except that one thing.”
- “This is my recommendation as your doctor. I do want to know what you think about it.”
Pitfalls that lose marks
- Asking “do you want us to resuscitate you?” — it is not a menu choice, and the question misleads.
- Letting them think DNACPR means no antibiotics, no fluids, no escalation.
- Making the decision without any discussion at all — unlawful, per *Tracey*.
- Using “we would not be able to do anything for you” instead of naming what you WILL do.
- Having the conversation for the first time when the patient is already peri-arrest.