DNACPR discussion

candidate brief

You have just seen Mr Roberts, a 89yo presenting to ED with exacerbation of COPD.

actor brief

examiner brief

89yo background of COPD not suitable for home NIV has presented for the 5th time in the last year with IECOPD

PMH: COPD, ischaemic heart disease with previous CABG 1998 and 2015, heart failure

BD POC, walks with 2 sticks

Generic script

  • Wash hands, introduce self
  • Verify patient's identity
  • Gain consent to have discussion
  • Past medical history including severity of chronic conditions
  • Drug history and allergies
  • Social history - baseline mobility, care needs
  • Explore patient's wishes re CPR, invasive ventilation etc.
  • Explore patient's understanding of CPR, previous similar discussions
  • Explain what resuscitation refers to - CPR, life-sustaining treatment
  • Explain likely futile nature of treatment
  • use of silence
  • agreed plan/ceiling of treatment
  • offer time to think about it and/or consult family
  • invite questions
  • addresses concerns
  • thanks patient + family

family discussion

Son appears - very angry that DNACPR decision was made for father, wants to dispute this. Initially very agitated, threatening litigation

  • Introduce self
  • ensure private place
  • Consent from patient to have this conversation if applicable
  • Clarify son's understanding of father's illness
  • Clarify patient's previously expressed wishes
  • Allows family member to express concerns
  • Explore family's understanding of CPR
  • Explain what resuscitation refers to - CPR, life-sustaining treatment
  • explain likely futile nature of treatment given co-morbidities
  • Explain treatment and investigations for reversible causes of illness will continue regardless of DNACPR status
  • use of silence
  • agreed plan/ceiling of treatment
  • offer time to think about it and/or consult family
  • invite questions
  • addresses concerns
  • thanks patient + family