A personal account of Treatment Escalation Discussions for my Mum

I have just recorded this little video to help explain the process I went through regarding my Mum and DNR discussions.

The three key questions that I refer to in the video are:

  • How would the treatment affect my loved one? / What would the likely outcome be?
  • What treatments would be given instead?
  • Where would those treatments be given and if in the community, how would those treatments be arranged so they would be timely and supportive?

…and In light of the Covid Pandemic:

  • Are Care homes being supported to give care of any residents with Covid?
  • Is NHS in the Community being supported to give community based Covid Care?

The discussions were with my Mum’s Care Managers. I could have had further discussion with my Mum’s GP but I did not feel that was necessary in my Mum’s case. I felt satisfied with the knowledge and experience of the people I had the discussions with (they were Care Managers and they were also ex-NHS nurses).

(N.B. I realise how much I touched my face in the video – I will endeavour to improve on this!! I had just washed my hands…but still bad!)

I found these other resources/ articles to be helpful too:

This Guardian article is very informative and compassionate written by a palliative care doctor, Rachel Clarke

Key paragraph: “Some people fear a DNACPR order means nothing at all will be done to try and prolong a patient’s life. This is not true. All manner of other treatments may be appropriate, such as fluids, antibiotics, oxygen, admission to hospital or treatment in an intensive care unit. The only thing ruled out by a DNACPR is chest compressions and shocks to the heart.”

This BMA document

The paragrapgh that jumped out at me was “5.1…A decision not to attempt CPR applies only to CPR….All other appropriate treatment and care for that person should continue. It is important that this is widely understood by healthcare professionals and that it is made clear to patients and those close to them. This is essential as it is a common fear amongst members of the public that a ‘DNACPR’ decision will lead to withholding of other elements of treatment.”

This BGS document is about how to manage Covid outbreaks in Care homes. My mum’s care home, GP and NHS are building even stronger links in the pandemic. However, there needs to be support from legislators in light of the pandemic to make sure they can hold stocks of the commonly used palliative medications. I will continue to research this and write to MP etc.

“Care homes should therefore work with GPs and local pharmacists to recognise and anticipate residents who are approaching the end of life and to ensure that anticipatory medications are prescribed in a timely fashion.  Legislators should work to make it possible for care homes to hold stocks of regularly used anticipatory medicines so that they can be prescribed and dispensed at short notice during the pandemic, in order to avoid delays to care for residents approaching the end of life”.