There is a lack of public awareness and knowledge about DNACPR
Throughout our research, public awareness of the realities of CPR and knowledge about DNACPR notices was mentioned by doctors, nurses and members of the public as an area for improvement. This is also implied in complaints we have received where patients and their families have challenged a DNACPR notice, but we have often not upheld this part of the complaint due the clinical nature of the decision.
“When some people found out about a DNACPR decision and were not asked for their consent, they were angry that the decision was imposed on them because they felt they had a right to be asked for permission. This common misconception urgently needs to be addressed.”
Compassion in Dying research, page 8
Public perceptions of DNACPR processes are often different from the reality. Our doctor’s survey highlighted some frequently misunderstood points about DNACPR, including that:
- applying a DNACPR notice is an evidence-based decision about the likelihood of the patient’s recovery and does not mean other treatment should not be given
- survival rates from CPR are poorer than they are often assumed to be, between an average of 12% for out-of-hospital cardiac arrests to 24-40% for in-hospital arrests (BMJ, ‘Patients overestimate the success of CPR’)
- even when CPR is successful and the return of spontaneous circulation (ROSC) is achieved, patients will often be too ill to have an acceptable quality of life
- patients and next of kin believe they have the right to request CPR as an option, rather than it being a medical decision made by the doctor.
87% of doctor respondents said more public education was needed around CPR and DNACPRs. To achieve this, many respondents, along with other healthcare professionals we spoke with and the Compassion in Dying research, recommended a public information campaign and information for an audience as young as school pupils around death and dying, the realities of CPR and DNACPR. The MOG recommended this to the Department for Health and Social Care, but it has not been actioned.
Improving understanding could help patients and their families and carers engage in conversations about DNACPR and death more generally. It would also allow patients to prepare in advance so that when the conversation happens, it does not come as a shock.
This was reflected in evidence from focus groups with people with learning disabilities, where there was confusion on rights around DNACPRs and a perception that the notice could also deny further treatment. It was also the experience of some clinical stakeholders we spoke to. The perception that DNACPRs symbolise a ‘ceiling of care’ is damaging trust around DNACPR conversations as a whole.
Too often in our research we heard from family members distraught about making what they saw as decisions on whether their loved one should live or die, which were never their decisions to make. We hope this report can help to start a more open conversation about death and dying among the general public and in the health service.