How is the Term 'Harm' Being Interpreted and Documented on Hospice DNACPR Forms Following the Tracey Judgement?

To investigate how discussions surrounding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions have changed following the Tracey judgement and how "harm" is being defined by clinicians working within specialist palliative care in a hospice setting.

Study Overview

• Status: Completed
• Conditions: Cardiopulmonary Resuscitation
• Intervention / Treatment: Other: Review of notes

Detailed Description

This is a retrospective case note review. Five hospices within the West Midlands will be invited to participate and up to 300 sets of deceased patients' notes containing a DNACPR form will be reviewed; 150 from 2013 (prior to the Tracey judgement) and 150 from 2015 (following the Tracey judgement).

Initially these forms will be reviewed to document the percentage of patients with whom a DNACPR decision was discussed in 2013 and the percentage with whom it was discussed in 2015 to allow comparison from before the Tracey judgement and after the Tracey judgement.

If patients did NOT have DNACPR decisions discussed with them, their DNACPR forms and clinical notes will then be reviewed and the reasons documented for not involving patients in 2013 and in 2015 compared. It is anticipated that many, if not most, DNACPR decisions which were not discussed with patients in 2013 will cite "distress" as the reason but following the Tracey judgement this would not be acceptable in 2015.

Further analysis of DNACPR forms and clinical notes will then take place for those patients identified as not being involved in DNACPR discussions in 2015 (post-Tracey) to identify whether, and how, "harm" was defined by the clinician. This should be recorded on the DNACPR form or in the clinical notes.

Following data collection, quantitative analysis will be undertaken to allow comparison of percentages of DNACPR decisions discussed with patients in 2013 and 2015 followed by descriptive analysis of variation in reasons for not discussing DNACPR decisions in 2013 and 2015. This study is explorative in nature and further qualitative analysis will not be part of this research project.

• Study Type: Observational
• Enrollment (Actual): 300

Contacts and Locations

Study Locations

• United Kingdom
  • Wolverhampton, United Kingdom, WV3 9DH
    • Compton Hospice

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Deceased patients' notes will be reviewed from 2013 (prior to the Tracey judgement) and from 2015 (following the Tracey judgement).

Description

Inclusion Criteria:

• Patients who died in 2013 or 2015 known to the individual hospice team (in-patient unit, day unit or community team)
• Completed DNACPR form within the clinical notes which was completed in 2013 or 2015

Exclusion Criteria:

• No completed DNACPR form within the clinical notes
• DNACPR form not completed in 2013 or 2015

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Year 2013; Participant's notes will be reviewed from the year 2013	Other: Review of notes; No intervention will occur
Year 2015; Participant's notes will be reviewed from the year 2015	Other: Review of notes; No intervention will occur

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The number of DNACPR decisions	1) The number of DNACPR decisions which were discussed with patients in 2013 (prior to the Tracey judgement) and in 2015 (following the Tracey judgement)	1 year
The reasons for not discussing DNACPR decisions	2) The reasons documented on DNACPR forms and in clinical notes for not discussing DNACPR decisions in 2013 and in 2015	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The documentation of the concept of 'harm' in DNACPR decisions	The documentation of the concept of 'harm' in DNACPR decisions not discussed with patients in 2015	1 year

Collaborators and Investigators

• Sponsor: The Royal Wolverhampton Hospitals NHS Trust

Study record dates

Study Major Dates

• Study Start (Actual): July 24, 2017
• Primary Completion (Actual): October 31, 2018
• Study Completion (Actual): October 31, 2018

Study Registration Dates

• First Submitted: June 20, 2017
• First Submitted That Met QC Criteria: June 20, 2017
• First Posted (Actual): June 22, 2017

Study Record Updates

• Last Update Posted (Actual): June 19, 2019
• Last Update Submitted That Met QC Criteria: June 18, 2019
• Last Verified: June 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: 2017PAL94

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No