Improving Discussions About Resuscitation With Frail Older Adults: Clinicians’ Perspectives

Background Frailty is a poor prognostic indicator following cardiopulmonary resuscitation (CPR). Discussions about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are often contentious. While existing research focuses on patients’ and relatives’ perspectives, there is a lack of in-depth studies exploring clinicians' experiences of DNACPR discussions. This study aims to explore how clinicians' personal and professional beliefs and experiences influence their approach to DNACPR conversations with frail, older adults. 

Methods Ninety clinicians from primary and secondary care across the UK, all experienced in resuscitation discussions with frail older patients, participated in either semi-structured interviews (n=45) or focus groups (n=5). Participants included doctors of various grades, nurses, and advanced practitioners. Data were analysed using thematic analysis. 

Results Four key clinician-related themes emerged: professional experience, specialty culture, emotional response, and personal values. Some junior clinicians reported a lack of confidence in leading DNACPR discussions. Participants described how specialty culture shaped approaches, with geriatricians and palliative care teams most likely to initiate discussions. Some clinicians reported agreeing to CPR decisions that contradicted their medical judgment to avoid conflict with patients or families. Many expressed a personal preference for non-resuscitation in similar circumstances, influenced by professional exposure. A lack of formal training and a reliance on an informal “apprenticeship model” were also commonly reported. 

Conclusion Clinician-specific factors appear to be important in DNACPR conversations with frail older adults. Addressing the personal and emotional aspects of these discussions is essential to improving clinician confidence and the overall quality of resuscitation decision-making.