NHS Lanarkshire to apologise after partner found out patient's cancer was fatal from Do Not Resucitate form

A health board has been ordered to issue an apology after the spouse of a patient who died of advanced lung cancer “didn’t understand” their condition was terminal.

The Scottish Public Services Ombudsman (SPSO) has instructed NHS Lanarkshire to apologise to the patient’s spouse, referred to as B to protect their anonymity.

B’s spouse, referred to as A, started experiencing pain between their shoulder blades and was recommended by a GP to attend A&E at University Hospital Hairmyres for a chest x-ray.

A went to A&E at the hospital on three separate occasions and received more x-rays, after which they were admitted to University Hospital Wishaw where they underwent further investigation – leading to A being diagnosed with advanced lung cancer.

C, B’s advocate, complained about the clinical assessment of A’s symptoms when they attended A&E.

C also claimed A had signed a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form during a hospital admission when they “did not have capacity” to understand it, and that B was unhappy that they had not been consulted about the DNACPR.

Furthermore, C claimed that communication about A’s diagnosis was “very poor”, and that A was not informed that their cancer was life-limiting or terminal. B claimed they were unaware that A only had a short time left to live.

The SPSO turned to independent advice from an emergency medicine adviser, who found A’s symptoms had been correctly diagnosed and treated during each of their visits to A&E, as well as “appropriately referred for further investigation”. This complaint was not upheld by the ombudsman.

Following advice from a consultant physician, the SPSO also found A’s capacity to consent to a DNACPR was “appropriately assessed”, and consent was “reasonably obtained”.

The ombudsman considered that staff had no obligation to discuss the DNACPR with A’s family, and noted that A was admitted to hospital during the beginning of the Covid-19 pandemic when restrictions for visits were in place and hospitals were under considerable pressure. This complaint was also not upheld.

Finally, the ombudsman decided that there was a disparity between what medical staff thought A’s family understood about their condition and its severity, and what they actually understood.

However it was found it was “not possible” to determine if this was due to a failure of communication or the family’s failure to grasp what they had been told.

The watchdog also took into account that A’s spouse said they had no idea how ill they truly were until they found the DNACPR form, which stated they were not expected to live more than 28 days.

In recognition of the impact that this must have had on B and taking into account that A’s family did not feel sufficiently informed about A’s condition throughout their illness, on balance, the SPSO upheld the complaint that the board’s communication regarding A’s condition was “unreasonable”.

As a result of the findings of the investigation, NHS Lanarkshire was ordered to apologise to B for failings in communication.

The SPSO added the case should form part of the annual appraisal for staff involved in communicating A’s condition, with training undertaken where any gaps are identified.

Judith Park, director of acute services at NHS Lanarkshire, said: “We understand this has been an extremely difficult time for the family and our thoughts and sympathies remain with them.

“We regret any instance where families feel that we have not communicated with them sufficiently.

“We have fully accepted the recommendations within the Ombudsman’s reports and lessons learned will be shared to help avoid similar occurrences in future.”