DNAR

Scenario

Your role: You are a medical doctor in medical ward

Problem: Discussion about Do Not Attempt Resuscitation (DNAR)

Patient: Mr. Robert Patterson, a 68-year-old man

Relative: Ms. Jennifer Patterson (Daughter)

Mr. Patterson has been diagnosed with stage IV lung cancer that has spread to his bones and liver. Despite aggressive treatment including chemotherapy, his disease has progressed, and recent imaging shows further spread. His quality of life is decreasing, and he experiences significant pain, fatigue, and breathlessness. The prognosis is poor, with the expectation that he has less than six months to live. Multidisciplinary team has decided that he would be for palliative care.

Your task is to discuss with Ms. Jennifer Patterson, his daughter, about the management plan adn DNAR, explaining what it entails, its importance in his case, and address her concerns. You have got permission from the patient to talk to his daughter.

DO NOT EXAMINE THE PATIENT. DO NOT TAKE A HISTORY.

Any notes you make must be handed to the examiners at the end of the station.

Conducting the Station: A Step-by-Step Guide

Introduction and Setting:

Begin by introducing yourself to Ms. Jennifer Patterson. Tell her that you have got permission from the father to talk to her. Ensure that the setting is comfortable and private to foster a conducive environment for sensitive conversations.

Explaining the Current Condition:

Provide a clear and straightforward explanation of Mr. Patterson's current health status. Ensure that Ms. Patterson understands the severity of her father's condition and his prognosis.

Introducing DNAR and Palliative Care:

Explain the concepts of DNAR and palliative care. Emphasize that the priority of both these strategies is to maximize patient comfort and dignity, particularly when curative treatments are no longer beneficial or desired.

DNAR Explanation:

Elaborate on DNAR, its implications, and its role in end-of-life care. It means that in the event of cardiac arrest, no attempts will be made to restart the heart. The purpose is to prevent unnecessary suffering or discomfort in patients who are nearing the end of their lives or have a terminal illness.

Palliative Care Explanation:

Explain the role of palliative care, which is focused on comfort, pain management, and maximising quality of life for patients with serious illness.

Addressing Concerns:

Encourage Ms. Patterson to share her feelings, thoughts, and concerns. Address them empathetically and provide factual information to help her understand and make informed decisions.

Discussing Best Interests:

Explain that this plan is being considered in the context of his best interests, given his current health status and prognosis.

Offer Support:

Offer additional resources, if needed, for support during this challenging time such as counseling services, support groups, and further reading.

Summarise and Close:

Recap the main points of the conversation, and confirm Ms. Patterson's understanding. Reiterate your availability for any further questions or concerns.