Reflective Learning from Do Not Intubate/Do Not Resuscitate Conversations: A Qualitative Study Using Gibbs Reflective...

Do Not Intubate/Do Not Resuscitate (DNI/DNR) decisions are made when a patient has declined resuscitation, has a poor prognosis or if the patient will not survive intubation with sufficient quality of life. The DNI/DNR discussion is always a complex communication process. The primary objective of the study was to describe the reflections on the experience during conversations on DNI/DNR with the family members of the patients referred for palliative care and conversations through a focus group discussion (FGD) with other medical specialty trainees to improve learning through self-reflection.

This is a qualitative study. A qualitative reflective study of DNI/DNR conversations was made. Reflections on various experiences during the conversation were carried out using the Gibbs reflective tool. FGD with six other speciality post-graduate trainee doctors was audio recorded after informed consent, transcribed verbatim and thematically analysed.

Reflections on self-experience during DNI/DNR conversations were summarised under the following: (i) Difficult conversation, (ii) lack of communication and denial, (iii) influence of financial background and (iv) emotional burden on healthcare workers. Themes identified included factors influencing DNI/DNR conversations (patient demographics and disease onset, early initiation of discussions, empathic communication, and rapport building), emotional burden on healthcare workers, and the need for multiple discussion sessions.

The analysis revealed that every conversation differs depending on the patient and his or her family members' perspectives. Reflections on various conversations help to identify flaws and improve one's communication skills. Communication skills might improve by practising self-reflection, attending communication skill classes and observing seniors.