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Tue, 20 October 2020

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Half of people do not understand DNRs, new polling from Compassion in Dying finds

Compassion in Dying

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More than half of people do not understand DNR orders (Do Not Resuscitate, also known as Do Not Attempt Cardiopulmonary Resuscitation or DNACPR), new polling from Compassion in Dying has found.

. A recent survey by YouGov commissioned by the charity found that most people did not know that a DNR decision is made if a clinician thinks that attempting CPR will do more harm than good (51%), that a DNR decision must be explained to a patient and/or their family (54%), or that a patient will still continue to receive other care if a DNR decision is made (51%).

The charity, which helps people prepare for the end of life including how to talk about it, plan for it and record their wishes, regularly receives calls to its free, nurse-led information line on the topic of CPR (cardiopulmonary resuscitation) and DNRs, and queries on this topic have almost doubled since August 2020.

Compassion in Dying has heard several reports of poor and unlawful practice related to DNRs during the coronavirus pandemic, including DNRs being issued in a blanket fashion or without explanation to the patient or their family, as well as people feeling ignored or misunderstood when they want to discuss their wish to be protected from potentially harmful or futile CPR. The charity has been calling for an inquiry into DNRs and other end-of-life decisions during the pandemic, and submitted evidence on its concerns to the House of Lords ‘Life beyond COVID’ committee in August. The charity now looks forward to working with the Care Quality Commission (CQC) on a rapid review into the use of DNRs during the pandemic, announced today (Monday 12 October 2020).

The charity is also calling for new guidance on DNRs from NHS England and Improvement to be published as a matter of urgency. In July 2020 the Health Secretary heeded calls from Compassion in Dying and campaigner Kate Masters for clear, national guidance after they threatened legal action, however a timeline for the publication of this guidance is yet to be announced.

YouGov polling also found that, if a healthcare professional were to raise the topic of DNRs with them, more than three-quarters (77%) of people would either welcome the conversation (38%) or be willing to explore the topic, even if it worried them (39%). Just 6% said they would not want to talk about it.

Usha Grieve, Director of Partnerships and Information at Compassion in Dying, said:

“As we face a second wave of coronavirus, we must recognise and learn from the mistakes of the first and we welcome the CQC’s announcement today of a rapid review into the use of DNRs. We have called for an inquiry into these issues for some time and look forward to working with the CQC to share our insights, having received several reports of poor and unlawful practice related to DNRs before and during the pandemic.

“Coronavirus has highlighted and exacerbated ongoing problems with decision-making and communication around DNRs, which have proliferated under a lack of clear, national guidance. This has had devastating effects on patients and families right across the spectrum – from DNRs being issued in a blanket way, to decisions not being properly communicated or explained to patients or families, to people who want to protect themselves from potentially harmful or futile CPR feeling ignored.

“Our new polling further underscores the urgent need for clear, national guidance on DNR and for more open, honest communication between healthcare professionals, patients and families. More than half of people do not understand how DNR decisions are made, that decisions must be explained to patients and families, or that if a DNR decision is made they will still receive other care. However, clearly patients are open to having these conversations, with more than three-quarters of people saying they would be fine with a clinician raising the topic of DNRs with them. If we are to ensure that end-of-life care is truly person-centred – and lawful - then we cannot shy away from having these important conversations in a timely, open and sensitive way. A transformation of end-of-life care is much-needed and long overdue, and coronavirus can and should be seen as a catalyst to forge a more compassionate, patient-centred approach.”

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