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