Escalation plans and DNACPR discussions in the unwell oncology patient

Abstract

Background: Patients with advanced end stage cancer have 5) oncology inpatients admitted to LRI. Using a data collection tool, we primarily identified the proportion of patients who had a DNACPR decision. Furthermore, we analysed timeliness of DNACPR decisions, involvement of patients' own oncology team and documentation of prognosis/ escalation plans. Liaising with healthcare professionals from oncology & palliative care we formulated ideas to improve outcomes. Enhancing communication between permanent ward staff (nurses & junior doctors) and senior decision makers (oncology registrars & consultants) was vital to improve outcomes. We therefore empowered junior doctors/nursing staff to identify patients who needed DNACPR discussions using a proforma tool utilising board round meetings as a platform. Data was then analysed to compare outcomes. Results: Qualitative data showed improved confidence for junior doctors in identifying & communicating DNACPR discussions. Conclusions: Empowering junior doctors and simple departmental changes lead to a significant improvement in communicating and implementing DNACPR decisions. We therefore significantly reduced unnecessary CPR attempts and subsequently improved communication and documentation of escalation plans and prognosis. We believe our model can be implemented in other oncology centres and look forward to discussing this further.