Navigating DNACPR decisions: a qualitative study of DNACPR factor variability and implementation among NHS Doctors

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Healthcare Policy

Background:

• The absence of a national Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy creates a guidance gap for clinicians.
• Previous studies identified concerns regarding the lack of explicit criteria for DNACPR decisions.

Purpose of the Study:

• To explore clinicians' personal strategies for assessing patients in DNACPR decision-making.
• To understand the extent to which clinicians value professional autonomy in DNACPR decisions.

Main Methods:

• Conducted 16 semi-structured interviews with NHS clinicians via video calls.
• Employed snowball sampling for participant recruitment.
• Utilized inductive thematic analysis of interview transcripts.

Main Results:

• Clinicians consider age, frailty, quality of life, and perceived outcomes in DNACPR decisions.
• Significant variation exists in how these factors are assessed and prioritized.
• Decisions are often based on individual judgment and local conventions due to lack of standardized guidance.

Conclusions:

• Physician-level variation in DNACPR decisions highlights the tension between patient needs and the lack of standardized guidance.
• Case-by-case decision-making allows nuanced judgment but risks inadvertent bias.
• A national DNACPR policy is recommended to provide a framework while preserving clinical autonomy and ensuring evidence-based practice.