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Background: There have been numerous anecdotal reports from doctors in East Sussex Healthcare Trust (ESHT) about the
difficulties in discussing escalation and resuscitation with patients. We feel the wording of Do Not Attempt Cardiopulmonary
Resuscitation (DNACPR) is negative and detrimental to these discussions. The Gold Standard Framework and the GMC
recognise an alternative wording: Allow Natural Death. Our project was looking to change the wording of these forms to Allow
Natural Death (Do Not Attempt Cardiopulmonary Resuscitation) in an effort to improve this difficult conversation.
Sampling Methods: An online survey was emailed to all doctors at ESHT over a four week period. We received 132 responses
from FY1 to consultant.
Results: There were many reasons why doctors felt patients disagreed with DNACPR decisions. 43% felt the wording of
DNACPR forms contributed. Other factors included: poor understanding of CPR prognosis (82%), poor understanding of
their prognosis (67%) and family member influence (55%). On a scale of 0 (very negative)-5 (very positive) the wording
of DNACPR scored on average 2.55 compared to a score of 3.74 for AND, a 48% improvement. 66% felt that substitution
of DNACPR with AND (DNACPR) would help counteract poor patient response to discussion. Perceived barriers to this
change included: difficulty changing established protocol (34%), confusing for medical staff (44%) and no obvious change in
discussion (27%).
Conclusions: There are numerous contributing factors to patient resistance to resuscitation decisions. The wording of DNACPR
forms was felt to be a significant contributing factor. Doctors felt that re-wording of these forms to Allow Natural Death
(DNACPR) would help improve discussions. In the coming months there will be several educational events to promote this
form in conjunction with good discussion technique. The proposal to change the wording will be submitted to the resuscitation
and end of life committees.
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