Last year I made some infographics about #HaveTheConversation.
"The Purple One" - full of phrases to help HCPs discuss death and dying and the need for DNACPR with patients/families (with the phrases supplied by the Twitter hive-mind, particularly Dr Gordon Caldwell) - went viral, and has been seen by more than quarter of a million people on Twitter alone and shared hundreds of times on Facebook; the patient-facing "Peaceful Death" one did well too. I have even seen them "in the wild", on the walls of resus departments in other hospitals! You can find both (and download full-resolution PDFs) on the #HaveTheConversation page on this website.
I have been extremely touched to receive some lovely Twitter messages from paramedics who have found these materials helpful when supporting dying patients and their relatives, and resisting the pressure to race off to the hospital that usually accompanies a 999 call to a desperately unwell patient. One even showed me (anonymised, naturally) a thank-you letter from grateful relatives, and said, "I just wanted to say thanks so much for all the stuff you’ve done on EoL care and frail elderly patients. It genuinely gave me the confidence to recognise what was happening and have some difficult conversations with this family and ultimately let the patient have a peaceful death...". This is what this is all about, and why I've just spent a Sunday evening at the Mac.
I am sometimes asked "why do you push DNACPR as the first thing in anticipatory care planning, instead of working up to it?". Well, there are two reasons.
Firstly, because DNACPR conversations are the ones that far too many HCPs are reluctant to have (despite evidence that elderly patients WANT to #havetheconversation) and failing to "clinch the deal" to ensure the protection of a DNACPR form is in place in time has awful consequences for the patient and their family if the grim reaper beats you to it.
Secondly, because I find DNACPR discussions in very old, frail and/or ill patients are usually quick and easy once you have got the hang of doing them routinely - I find completing a TEP form (we don't use ReSPECT forms in North Wales) takes much longer.
Elderly people who have been going to friends' funerals every few weeks for years - the way that we went to friends' weddings throughout the summers of our third decade - know perfectly well that their time left on earth is limited. The vast majority I find to be extremely pragmatic and are quite happy to be advised that trying to restart their heart would be inappropriate and/or unlikely to work and so should not be attempted. I have noticed, however, that middle-aged offspring can find these discussions much trickier than their mum or dad, from whom there is often palpable relief when you #Havetheconversation. I do it as part of the social history - just make it routine! - alcohol, fags, do you have any PoA or DNACPR forms I need to make a note of...
What's more, DNACPR chats can be remarkably cheerful, and laced with moments of macabre humour - "The only way I want to leave my farm is in a six-foot box" - "Well, you do know there's a form for that?". Frankly, the most awkward bit is actually deciding what to write on the envelope containing the copy of their DNACPR form they go home with, and if anyone has any suggestions, I'd love to hear them!
However, I was recently asked to produce a version of the "Peaceful Death" poster (it looks best printed out A3 or bigger - here's the PDF) that mentioned ReSPECT forms, so I have gone the whole hog and revised it totally. You will find it now includes mention of DNACPR, ReSPECT/TEP and prompts about considering Powers of Attorney and ADRTs.
I'm always up for suggestions, good ones I will try to deliver on eventually (!), please do drop me a line on Twitter (@DrLindaDykes) with any feedback.