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Do not attempt cardiopulmonary resuscitation decision-making process: scoping review
Owen Doody1, Hope Davidson2, John Lombard2
1Nursing and Midwifery, University of Limerick, Limerick, Ireland owen.doody@ul.ie.
BMJ Supportive & Palliative Care
|March 22, 2024
Summary
Understanding do not attempt cardiopulmonary resuscitation (DNACPR) decision-making is complex. Key barriers include poor communication and timing, while facilitators involve ongoing discussion and clear policies, highlighting the need for improved practices.
Area of Science:
- Medical Ethics
- Healthcare Policy
- Clinical Decision-Making
Background:
- Do not attempt cardiopulmonary resuscitation (DNACPR) decisions are critical but complex.
- Evidence on the DNACPR decision-making process requires synthesis.
Purpose of the Study:
- To conduct a scoping review of the evidence on DNACPR decision-making processes.
- To identify barriers and facilitators influencing DNACPR decisions.
Main Methods:
- Systematic search of eight databases (January 2013 - April 2023).
- Screening of 66,207 search results, with 58 papers included.
- Content analysis mapped onto a conceptual framework.
Main Results:
- Identified factors: timing, patient/family involvement, discussion, documentation, communication, and adherence.
- Barriers: poor timing, limited input, communication issues, ethical uncertainty.
- Facilitators: ongoing conversation, adequate time, documentation, clear policies, good communication.
Conclusions:
- DNACPR decision-making is complex, influenced by law, policy, resources, professionals, and patients.
- Substantial changes are needed to support and promote good practice in DNACPR implementation.
- Addressing barriers and enhancing facilitators is crucial for effective DNACPR processes.
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