Communication Station 1
Station 1
A DNACPR decision
Candidate Instructions
Setting:
You are a junior doctor on the wards. Your consultant has asked you to explain a DNACPR decision to a patient’s family. They have power of attorney as the patient no longer has capacity. The patient is currently stable, this is just a precaution for if he declines. The consultant has stated CPR would NOT be in the patients best interest.
Name: Brian Yudowski
Tasks:
1. Explain DNACPR to the patient’s son.
2. Answer any questions the son may have.
Simulated Patient Instructions
Briefing
You are Brian Yudowski, the son of Ian Yudowski.
Ian Yudowski has come into hospital with an exacerbation of his terminal lung cancer. The Dr has been asked to discuss a DNACPR decision.
Brian initially has no idea that a DNACPR decision will occur today. He has just come in to see his father, as he does every day.
Appearance and Behaviour
Brian initially has no idea that a DNACPR decision will occur today. He becomes visibly upset when it is mentioned, however with appropriate pauses and reassurance he is consolable and will allow the candidate to finish their explanation. He often holds his head in his hands but engages fully with the conversation.
Opening Statement
"Thank you so much for taking care of my father, I know he is very unwell and a bit confused at the moment but I know he is very happy to have you and the team looking after him."
Further Information
Ideas - “I know my father is slowly dying from lung cancer and he is here for palliative care”
Concerns - “I am concerned he will be uncomfortable when he passes”
Expectations - “I just want to do everything we can to keep him comfortable”
History of presenting complaint - The patient was diagnosed with terminal lung cancer 6 months ago, he has now been admitted into the hospital for palliative care. In the last medical update with Brian, it was said that he probably had 7-10 days to live. He has been becoming frailer over the past 6 months and Brian just wants to keep his father comfortable now.
Brian has never heard of DNACPR - but he does know what CPR is from TV shows (he loves scrubs and Grey's Anatomy). Him and his father have never discussed end-of-life care.
Brian agrees a DNACPR would be in his father's best interest.
Brian is open to receiving any information the doctor gives about DNACPR.
Triggers
On mentioning CPR the actor should become visibly upset, but you want what is best for your father and are happy to listen to what the doctor has to say.
Discussion / Questions
“So do you think this will help keep my father comfortable doctor?”
Start the Timer and Begin
Intro
Gathering Information
Giving Information
Conclusion
Brian thanked you for your explanation of DNACPR forms. He agreed it would be a good idea for his father to have one in place. Your consultant signed the form later that day and Brian’s father passed peacefully 5 days later.
Submit for Scoring
Tags | Counselling | DNACPR | CPR | OSCE communication station
Station Written by: Dr Benjamin Armstrong
Peer Reviewed by: Dr Rishil Patel