Research project – Improving Discussion about Resuscitation for Bereaved Relatives in COVID-19
Understanding the experiences of people who discussed resuscitation decisions with clinicians on behalf of their relative during the pandemic.
Outcomes after cardiopulmonary resuscitation (CPR) are often poor, especially for frail older people in hospital, most of whom do not survive.
A decision not to attempt CPR (DNACPR) can help avoid unnecessary and undignified treatment.
Since a 2014 Court of Appeal ruling, doctors must inform patients (or their relatives if the patient lacks capacity) when a DNACPR decision is made.
Even before the COVID-19 pandemic, DNACPR decisions were sometimes a source of criticism and complaints. The pandemic made things more difficult due to how quickly patients became seriously ill and the limits on in-person contact between doctors, patients and families.
Reports from organisations like the Care Quality Commission (CQC) highlighted poor practices around DNACPR decisions and how they were communicated during the pandemic (2020–2022).
Research also shows that more DNACPR decisions were made in 2020 than in previous years.
This research project aimed to understand the experiences of people who discussed DNACPR with a clinician on behalf of their relative during the pandemic.
39 relatives were interviewed as part of the project.
Project Lead: Professor Louise Tomkow
Local Lead: Dr Felicity Dewhurst, Consultant in Palliative Medicine, St Oswald’s Hospice.
NIHR PRP: Recovery, Renewal, Reset: Research to Inform Policy Responses to COVID-19
2021
This qualitative research aimed to understand the experiences of people who discussed DNACPR with a clinician on behalf of their relative during the pandemic.
39 relatives took part in semi-structured interviews via phone or video calls.
A patient and public involvement and engagement group (PIPE) was also commissioned to refine the research scope, develop the interview topic guide and guide analysis.
Data was analysed using Framework Analysis.
During the COVID-19 pandemic, DNACPR decisions caused ongoing distress for many families.
This research questions how decisions are made and how the legal framework affects clinical practice.
Coordinated action with individuals, families, care systems and the wider public could enhance relatives’ experiences of DNACPR discussions.
Greater public awareness, talking about DNACPR earlier within families, giving clinicians more time, and better training in communication skills could all help make these conversations easier and more supportive for relatives.
Read the published report below.
Download the report