Research project – Improving Discussion about Resuscitation in COVID-19
Experiences of relatives/carers around Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) conversations during the pandemic.
Between March – August 2020, most COVID-19 deaths occurred in hospital – around 33,000 in the UK.
The issue of communication with relatives/carers regarding Cardiopulmonary Resuscitation (CPR) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) for loved ones admitted to hospital during the pandemic was challenging due to untimely unexpected deaths and restrictions to face-to-face hospital visiting.
Good communication around care at end-of-life is important for relatives and carers and can help when coping with bereavement.
Complaints about poor resuscitation communication are common. They are distressing for patients and families and costly for the NHS.
The project used relatives/carers’ experiences to inform policy makers and health care providers about what worked well and what needed to be improved when discussing end-of-life issues in COVID-19.
Dr Lousie Tomkow, University of Manchester
Dr Felicity Dewhurst, Consultant of Palliative Medicine at St Oswald’s Hospice
June 2021 – May 2022
This research aimed to find out how discussions about resuscitation could have been improved for the relatives/carers of people who died in hospital of COVID-19.
The project used relatives /carers experiences to inform policy makers and health care providers about what worked well and what needed to be improved when discussing end-of-life issues in COVID-19.
Qualitative research was undertaken to explore the experiences of relatives/carers of people who died in hospital of COVID-19 with a DNACPR order in place.
39 relatives took part in semi-structured interviews using telephone or video conferencing software.
A patient and public involvement and engagement group (PPIE) was commissioned to refine the research scope; develop the interview topic guide, and guide analysis.
Specific questions included when and where discussions about resuscitation took place, and who led those discussions. The interviews also provided participants time to discuss other factors important to them.
Interviews were recorded and transcribed. A ‘Framework Analysis’ was used to analyse the data in a way useful for policy makers.
Bereavement support was offered to all participants after interview.
The research found that during the COVID-19 pandemic, discussion of DNACPR has been a source of enduring distress for many relatives.
This research raised questions about the current approach to DNACPR decision-making, including how the legal framework impacts on clinical practice.
Co-ordinated action at individual, family, care system and population levels has the potential to enhance relatives’ experiences of DNACPR discussions.
Better public understanding of DNACPR, early discussion in families, more time and communication skills training for clinicians, may all be helpful.
Read the published report below.
Read the report