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ACP & DNACPR · GCC Nursing Guide 2025

Advance Care Planning,
DNACPR & Goals of Care

From RESPECT forms to goals of care conversations, from DNACPR decision criteria to GCC cultural context — a complete nursing guide with interactive communication planning tool and exam-ready reference.

~20%
In-hospital CPR survival to discharge (general)
CFS ≥5
Frailty threshold prompting ACP discussion
2-Stage
Mental Capacity Act assessment required
30–60 min
Recommended time for GOC conversation
Advance Care Planning Nursing Guide

Navigate all six modules — from foundational concepts to GCC exam focus. Each tab is self-contained and examination-ready.

What is Advance Care Planning?

Advance Care Planning (ACP) is a voluntary process of reflection and communication through which a person, in consultation with their clinicians and loved ones, considers their values, wishes, and preferences for future care — particularly if they become unable to speak for themselves. ACP is not a single event; it is an ongoing conversation that evolves with the patient’s condition.

ACP is not the same as completing a form. Documentation is the record of a conversation — the conversation is the care.

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Key principle: ACP should happen before a crisis — in clinic, at home, or on a ward admission. Completing an ACP form at 2 am when a patient is deteriorating is not ideal and is often not possible when capacity is impaired.

Core Components of ACP

  • Values and preferences — what matters most to the patient; quality of life priorities
  • DNACPR decision — whether CPR should be attempted if the heart stops
  • Ceiling of treatment — upper limits of intervention agreed (ICU, NIV, antibiotics)
  • Preferred place of care and death — home, hospice, hospital, care home
  • Organ and tissue donation — patient’s wishes; consent or registration status
  • Lasting Power of Attorney (LPA) — who can make decisions if capacity lost (health and welfare LPA)
  • Spiritual and religious wishes — funeral preferences, last rites, family presence
ACP vs ADRT vs LPA
Document Who Completes Legal Status What It Does GCC Context
ACP
Advance Care Plan		 Patient (with clinician support) Not legally binding — guides care Records wishes, values, and preferences. Can include any aspect of future care. Widely practised in UAE and Qatar. RESPECT form used in many GCC hospitals.
ADRT
Advance Decision to Refuse Treatment		 Patient only (must have capacity) Legally binding (if valid and applicable — UK MCA 2005) Specifies treatments the patient refuses in named future circumstances. Cannot be used to demand treatment. Formal ADRT uncommon in GCC. Verbal refusals documented in notes are used. Check local policy.
LPA
Lasting Power of Attorney		 Patient registers with Office of the Public Guardian (UK) or equivalent Legally binding once registered Appoints a named person to make health/welfare decisions if patient loses capacity. Attorney must act in best interests. LPA not a formal legal instrument in most GCC countries. Family-centred substitute decision-making operates in practice.
Who Should Have ACP Discussions?

Clinical Triggers for ACP

  • Serious or life-limiting illness (cancer, advanced HF, ESRD, COPD on NIV)
  • Frailty — Clinical Frailty Scale (CFS) ≥5
  • Progressive neurological disease (MND, Parkinson’s disease dementia, advanced MS)
  • Dementia — especially when patient retains capacity for discussion
  • Multiple hospital admissions in prior 12 months
  • “Would you be surprised if this patient died in the next 12 months?” — answer No = ACP indicated
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ACP is not only for end-of-life. It is appropriate for any patient with a condition that may progress and impair capacity. The earlier the conversation, the more the patient’s own voice is preserved.

Documentation Forms by Region

  • RESPECT form (UK / adopted in many GCC hospitals) — Recommended Summary Plan for Emergency Care and Treatment. Covers CPR, emergency treatments, and care priorities.
  • POLST / MOLST (US-based) — Physician Orders for Life-Sustaining Treatment / Medical Orders for Life-Sustaining Treatment. Physician-signed; legally enforceable medical order.
  • UAE Healthcare System Directive forms — SEHA, DHCC, and private hospital groups each have adapted ACP documentation; check your hospital’s current form.
  • Saudi Arabia — No standardised national ACP form; documentation within progress notes and family meeting records is the norm.
GCC Cultural Context: In GCC countries, the family-centred model predominates. Patients may defer decision-making to family members. Islamic jurisprudence emphasises that care is obligatory, but extraordinary means that are futile are not. Physician-family discussions are common; nurse-to-patient ACP conversations should be aligned with the medical team’s approach.
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DNACPR: Do Not Attempt Cardiopulmonary Resuscitation. A medical decision that CPR will not be attempted if the patient’s heart stops. It does not mean “do not treat” — all other active treatment continues unless separately discussed under ceiling of treatment.

Who Makes the DNACPR Decision?

The DNACPR decision is made by the senior clinician (Consultant / Attending Physician). It is a medical decision based on clinical judgement about likely outcome and the patient’s wishes.

  • Nurses do NOT make the DNACPR decision independently
  • Nurses are central to communication, advocacy, and execution
  • Advanced Practice Nurses in some GCC hospitals may complete the DNACPR form under supervising consultant guidance — check your hospital policy
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Never assume DNACPR = no treatment. A DNACPR order applies only to CPR. The patient still receives all other appropriate treatments — analgesia, antibiotics, IV fluids — unless separately agreed with ceiling of treatment discussion.

Grounds for DNACPR Decision

  • Futility — CPR is very unlikely to result in survival to discharge (e.g. metastatic cancer, multi-organ failure, end-stage COPD)
  • Burdensome without benefit — CPR may restart the heart briefly but results in fractured ribs, hypoxic brain injury, ICU admission, and death days later with added suffering
  • Patient’s expressed wish — patient with capacity has stated they do not want CPR. This is the strongest basis.
  • Quality of life after CPR unacceptable to patient — patient has stated they would not want to survive in a dependent or severely impaired state
Saudi Arabia note: Some hospitals prohibit DNACPR orders, or require senior approval at Director of Medical Affairs level. Always check local hospital policy before completing a DNACPR form. In many GCC settings, the discussion focuses on “ceiling of treatment” rather than DNACPR specifically.
In-Hospital CPR — What the Evidence Shows
Patient GroupApproximate Survival to DischargeQuality of Survival
General in-hospital cardiac arrest (all comers)~15–25%Variable; many with neurological injury
Witnessed VF/VT arrest (shockable rhythm)Up to 40%Best outcomes — shockable rhythm most reversible
Non-shockable rhythm (PEA / asystole)5–12%Poor; common in end-stage illness
Cancer (metastatic / end-stage)<5%Very poor; most die in ICU post-CPR
Frailty CFS 7–9<5%Extremely poor; almost all die in ICU
Unwitnessed arrest<5%Very poor regardless of comorbidities
Communication & Documentation

Before Completing the DNACPR Form

  1. Assess patient capacity (2-stage MCA test if in doubt)
  2. Discuss with patient if capacity intact — explain the clinical reasoning
  3. Involve family / next of kin (patient consent needed to share with family if capacity intact)
  4. If capacity impaired — family meeting in best interests framework
  5. Document conversation: who present, what was said, what was agreed
  6. Complete DNACPR form — senior clinician signs
  7. Ensure all team members know: handover, visible in notes / red folder
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UK BMA guidance requires the patient is informed a DNACPR has been made (unless telling them would cause harm). GCC practice more commonly involves family-first communication. Follow your hospital’s policy but advocate for the patient’s voice to be heard.

DNACPR Form — Placement and Visibility

  • Front of patient notes (paper or electronic flag)
  • Red folder / brightly coloured wallet (hospital dependent)
  • Bedside or above the bed in some hospitals
  • Communicated at every handover via SBAR: “DNACPR in place — documented [date] by Dr [name]. Family aware: [yes/no].”
  • Transfer documents must include DNACPR status when transferring between wards, hospitals, or to community

Responding to “Do Everything” Requests

When families request “do everything”, do not be confrontational. The goal is to understand what they mean:

  • “Tell me more about what ‘everything’ means to you”
  • “What would your mother say if she could tell us herself?”
  • “We will always keep her comfortable and treat what can be treated”
  • Offer a family meeting with senior doctor + nurse + interpreter
  • Involve palliative care team early if conflict arises
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Goals of Care (GOC) conversations explore what matters most to the patient and family, clarify understanding of the illness trajectory, and align medical treatment decisions with the patient’s values. They are distinct from — and broader than — DNACPR discussions.

REMAP Framework

  • R — Reframe: When curative treatment is no longer effective, reframe the focus: “Our goal has shifted to keeping you as well as possible for as long as possible.”
  • E — Expect emotion: Pause. Allow silence. Respond to emotion before continuing: “I can see this is difficult to hear.”
  • M — Map the future: Explore prognosis honestly: “Can I share with you what I think might happen?” Use “I worry...” language.
  • A — Align with values: “Knowing what you’ve told me about what matters most, it sounds like your priority is [quality time at home / avoiding suffering / being with family].”
  • P — Plan: Concrete, care-focused plan: “So we will focus on symptom control, keeping you comfortable, and maximising your time at home.”

VALUES Framework

  • V — Value the patient as a whole person
  • A — Ask open-ended questions
  • L — Listen actively — do not interrupt
  • U — Understand what matters most to them
  • E — Empathise with their situation
  • S — Support the family unit, not just the patient

Setting the Scene

  • Private, quiet room — not a busy ward bay
  • Adequate uninterrupted time — allow 30–60 minutes
  • Key family members present (with patient’s consent)
  • Professional interpreter if English/Arabic not fluent — never use family as interpreter for consent discussions
  • Bereavement or chaplaincy support available if needed
  • Nurse should be present — not just the doctor

Key Phrases That Open Conversations

  • “What matters most to you right now?”
  • “What do you understand about your illness?”
  • “What would a good day look like for you?”
  • “If things get worse, what are you most afraid of?”
  • “Have you thought about what you would want if you became too unwell to speak for yourself?”
  • “Is there anything you would never want done to you?”
Avoid asking: “Do you want us to do everything?” — this question is unanswerable and misleading. Reframe: “Tell me about what ‘doing everything’ would mean for your loved one.”
Ceiling of Treatment — Discussing Each Component

Discuss whether admission to intensive care — with invasive ventilation, vasopressors, and organ support — is appropriate. In patients with terminal illness, frailty (CFS ≥6), or advanced dementia, ICU admission may prolong the dying process rather than reverse it.

Framing: “If [patient] became very unwell and could not breathe on their own, we have a machine that breathes for them in the intensive care unit. But there is a risk they would not survive to come off the machine, and the time in ICU would be very difficult. Have you thought about whether that is something [patient] would want?”

NIV (BiPAP/CPAP) is less invasive than intubation and may provide meaningful benefit in COPD exacerbations. However, in end-stage COPD, or in patients who cannot tolerate the mask, it may be burdensome without benefit. Discuss trial of NIV with clear end-points vs. comfort-focused care.

Key question: Is this treatment being offered with a realistic goal of recovery, or is it prolonging the dying process?

Antibiotics may still be appropriate in palliative patients to relieve distressing symptoms (e.g. treating a UTI for comfort, not for cure). The ceiling discussion clarifies: are we treating to cure, to prolong life, or to relieve symptoms? These are different goals and require different antibiotic strategies.

Framing: “We can still treat infections that are making [patient] uncomfortable. What we are discussing is whether we would send [patient] to ICU, or start very aggressive treatment, if things got much worse.”

In the last days of life, patients often stop eating and drinking — this is a natural part of dying and does not cause distress in most cases. Families may request “drips” believing dehydration is causing suffering. Evidence shows IV fluids in the dying phase can increase secretions, oedema, and discomfort.

Framing: “When the body is shutting down, it no longer needs fluid in the same way. Giving a drip can sometimes make people more uncomfortable rather than less. We focus on keeping the mouth moist and keeping [patient] comfortable.”

PEG tubes in advanced dementia do not improve survival, reduce aspiration pneumonia risk, or improve quality of life. In cancer, artificial nutrition in the last weeks of life does not extend meaningful survival. These are important GOC discussion points, especially in family-centred cultures where stopping feeding is perceived as “starving” the patient.

Framing: “Feeding tubes don’t replace the ability to eat and drink naturally. In someone whose illness is this advanced, studies show they don’t prevent infections, and they don’t make people live longer. The discomfort of placing the tube may outweigh any benefit.”

Islamic perspective: Providing food and water is considered obligatory care. However, where oral intake is physically impossible and tube feeding is futile, Islamic scholars have agreed it may be withdrawn or not started. Involve the hospital chaplain or Islamic ethics committee if needed.

CPR is discussed last in the ceiling of treatment framework — after the overall goals are aligned. If the patient and family have agreed on comfort-focused goals, DNACPR follows naturally. If they are seeking life prolongation at all costs, a careful honest conversation about CPR outcomes is needed.

Key point: DNACPR discussions should not be the opening of a GOC conversation — they should be the conclusion of one.

Documenting the GOC Conversation

What to Document

  • Date, time, and location of conversation
  • Who was present (patient, family members — named, interpreter, nurse, doctor)
  • Patient’s capacity status at time of conversation
  • Patient’s expressed wishes and values — in their own words where possible
  • Family’s understanding of the illness and prognosis
  • What was agreed: specific ceiling of treatment decisions (ICU yes/no, NIV yes/no, CPR yes/no)
  • Plan for next conversation / review date
  • Who to contact if patient deteriorates and further discussion is needed
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Document the conversation, not just the outcome. A DNACPR form alone is not sufficient. The notes must show the conversation happened, who was involved, and why the decision was made.

Nurse as Advocate

The nurse is often the clinician with the closest and most continuous relationship with the patient. This places nurses in a unique position to:

  • Recognise when a patient has not had an ACP conversation and flag this to the medical team
  • Understand the patient’s values, fears, and wishes from bedside conversations
  • Ensure the patient’s voice is heard in family and team meetings
  • Communicate the patient’s expressed preferences accurately to the wider team
  • Identify when a patient is being denied the opportunity to express their wishes

Completing ACP Documentation

  • In some GCC hospitals (particularly UAE), Advanced Practice Nurses can complete and sign ACP / RESPECT forms under supervising consultant oversight
  • Staff nurses can document ACP conversations in the nursing notes and flag for medical completion of the formal form
  • All nurses can complete the nursing ACP component: preferred place of care, spiritual needs, family preferences, comfort measures
  • Check your hospital’s scope of practice policy — never complete a DNACPR form without the authority to do so

Communicating DNACPR to Family

This conversation often falls to the nurse at the bedside. A suggested framework:

  1. Introduce yourself and establish the relationship: “I am [name], [patient’s] nurse today.”
  2. Check what they already know: “Can you tell me what the doctors have explained to you so far?”
  3. Explain the decision: “Dr [name] has made a decision about what would happen if [patient’s] heart were to stop.”
  4. State clearly: “The decision is that if [patient’s] heart stops, the team would not attempt to restart it. This is called a DNACPR decision.”
  5. Explain what will continue: “This does not mean we stop treating [patient]. We will continue all other treatments to keep them comfortable and well cared for.”
  6. Allow reaction — pause, offer empathy, answer questions. Offer chaplaincy or bereavement support.
Specific Nursing Responsibilities

ACP information must be included in every SBAR handover for relevant patients:

  • S (Situation): “[Patient] is a 78-year-old with end-stage COPD — DNACPR in place”
  • B (Background): “DNACPR documented [date] by Dr [name]. Family meeting held [date] — son and daughter present and aware.”
  • A (Assessment): “Current ceiling of treatment: ward-based care only — no ICU, trial of NIV if needed for comfort. Active palliation.”
  • R (Recommendation): “If further deterioration, comfort measures only. Contact palliative care team if needed. Family to be called if significant change.”

At transfer to another ward or hospital, ensure DNACPR form travels with the patient. Do not assume the receiving team knows.

When treatment is withdrawn in the ICU or ward setting, the nurse’s focus shifts entirely to symptom management and dignity:

  • Dyspnoea — morphine 2–5 mg SC/IV PRN; low-dose benzodiazepine for air hunger. Fan to face can reduce breathlessness perception.
  • Agitation / distress — midazolam 2.5–5 mg SC PRN. Review reversible causes (urinary retention, pain, constipation).
  • Secretions (“death rattle”) — repositioning, hyoscine butylbromide 20 mg SC. Reassure family this does not cause distress.
  • Pain — regular opioid analgesia, do not allow breakthrough pain. Anticipatory medications prescribed and available.
  • Family presence — unrestricted visiting in last hours. Explain what dying looks like (Cheyne-Stokes breathing, mottling, cooling of extremities).

Families in distress may express anger, guilt, disbelief, or bargaining. The nurse’s role:

  • Active listening — do not rush to “fix” with information
  • Normalise the emotion: “It makes complete sense that you feel this way”
  • Explore underlying fears: “What worries you most about what is happening?”
  • Offer practical support: contact chaplain, social worker, or bereavement counsellor
  • If anger is directed at care quality — acknowledge the concern, do not become defensive, escalate to senior nurse or patient relations team
  • Last offices — culturally sensitive last offices; in Muslim patients, family may prefer to perform washing rites (ghusl). Offer privacy and support.
  • Bereavement support — offer condolences, provide bereavement information leaflets, signpost to support services
  • Organ donation conversation — if patient registered as donor or family had expressed wishes, refer to transplant coordinator. MOH UAE allows organ donation. Many GCC Islamic scholars have issued fatwas supporting organ donation.
  • Documentation — complete death verification documentation per hospital policy. Ensure DNACPR form is retained in notes for audit purposes.
  • Cultural discomfort with death discussions — many nurses (and families) from GCC and South Asian backgrounds feel uncomfortable raising death-related topics. Training in cultural humility and communication skills is essential.
  • Deference to senior staff — hierarchical hospital cultures may discourage nurses from flagging ACP needs to senior doctors. Advocate clearly, escalate through nursing chain if needed.
  • Language barriers — nurse, patient, and family may all have different first languages. Never conduct ACP conversations through family member interpreters. Use professional interpreters or telephone interpretation services.
  • Rotationally staffed nurses — in large GCC hospitals, frequent staff rotation means continuity is poor. ACP information must be documented clearly so any nurse can access and communicate it.
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Dementia & ACP
Capacity may fluctuate — document ACP while the patient retains it. Identify Lasting Power of Attorney (or equivalent proxy) early. Use simple language and short conversations when capacity is present. The patient’s previously expressed wishes should guide decisions even after capacity is lost.
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Paediatric ACP
Parents act as proxies using a best interests standard, not substituted judgement. Palliative care team must be involved early. Children over ~12 years (varies by country) may have developing capacity for involvement. Document carefully; ethics committee may be needed if family and team conflict.
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End-Stage Organ Failure
ACP discussions should occur earlier in the illness trajectory in ESRD, advanced HF (NYHA IV), and end-stage COPD — not at the crisis point. Nephrologist/cardiologist/respiratory physician should initiate; palliative team supports. Dialysis withdrawal is a valid patient choice and requires careful planning.
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Cancer Patients
Joint ACP discussion involving oncologist + palliative care team is ideal. Introduce ACP concept at cancer diagnosis, revisit at progression, increase frequency in last 12 months. Oncologists may be reluctant to initiate ACP — advocate for the patient’s right to plan.
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Sudden Deterioration (No Prior ACP)
Emergency GOC conversation: rapid but compassionate. Check electronic records and old notes for any prior wishes. Establish family contact. Senior clinician leads with nurse support. Document in real time. Make best-interests decisions where capacity is absent and no prior plan exists.
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ICU Patients
ACP should be initiated on day 3–5 if there is no improvement. Family meeting with intensivist + bedside nurse + interpreter. Palliative care consult for complex situations. Prognostication tools (e.g. APACHE, SOFA) can support conversations but are not prescriptive.
Mental Capacity Act 2005 — 2-Stage Assessment

Stage 1 — Diagnostic Test

Is there an impairment or disturbance in the functioning of the mind or brain?

  • Dementia
  • Delirium
  • Brain injury / stroke
  • Severe mental illness (acutely psychotic)
  • Unconsciousness / severe sedation

If YES, proceed to Stage 2. If NO, the person has capacity (even if making a decision others disagree with).

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MCA 2005 (UK) is the framework adopted in many GCC hospitals, particularly in UAE (DHA / DOH guidance). Always check your hospital’s specific capacity assessment policy.

Stage 2 — Functional Test

Does the impairment cause inability to:

  • Understand — the information relevant to the decision?
  • Retain — the information long enough to use it?
  • Use and weigh — the information as part of the decision-making process?
  • Communicate — the decision (by any means — speech, writing, gesture)?

If unable to do any one of the above due to the impairment, the person lacks capacity for that decision.

Capacity is decision-specific and time-specific. A patient may lack capacity for complex treatment decisions but retain capacity for simple preferences (preferred diet, who they want to visit).

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All adults are presumed to have capacity unless assessed otherwise. Never assume a patient lacks capacity based on diagnosis alone.
Organ Donation in the GCC

Key Points for Nurses

  • The UAE MOH and HAAD/DOH permit organ donation; UAE Federal Law No. 5 of 2016 regulates transplantation
  • Multiple GCC Islamic scholars and fatwa councils have issued rulings supporting organ donation as a charitable act (sadaqa jariya) — this is important context for conversations with families
  • Organ donation conversations should be separated from end-of-life care discussions — ideally conducted by a trained transplant coordinator, not the primary bedside nurse
  • If a patient is on the national donor register or has expressed donation wishes in their ACP, alert the transplant team early
  • Never assume a family will refuse donation based on religion or culture — sensitively explore wishes without presumption

🎓 DNACPR Decision Criteria

Q: What are the three main grounds for a DNACPR decision?
A: (1) Futility — CPR very unlikely to restore circulation to discharge; (2) Burden outweighs benefit — survival possible but quality of life after CPR unacceptable; (3) Patient’s expressed wish — patient with capacity has refused CPR.
Q: Who makes the DNACPR decision?
A: Senior clinician (Consultant / Attending Physician). The nurse’s role is communication and advocacy, not decision-making.
Q: A family requests “do everything” for a patient with metastatic cancer. What is the nurse’s first response?
A: Acknowledge their distress, explore what “everything” means to them, and facilitate a goals of care family meeting with the senior clinician. Do not immediately agree or disagree.
Q: Does a DNACPR order mean no active treatment?
A: No. DNACPR applies only to CPR. All other treatments continue unless ceiling of treatment has been separately discussed and documented.

⚖ Mental Capacity Act — 2-Stage Test

Q: What are the two stages of the MCA capacity assessment?
A: Stage 1 (diagnostic) — impairment/disturbance of mind or brain. Stage 2 (functional) — unable to understand, retain, use/weigh, or communicate a decision because of that impairment.
Q: A patient with dementia refuses a blood test. Does this mean they lack capacity?
A: Not automatically. A capacity assessment must be performed. Capacity is decision-specific. A person can refuse treatment even if others disagree with the decision.
Q: What does “capacity is presumed” mean?
A: Every adult is presumed to have capacity until assessed otherwise. You cannot assume lack of capacity based on diagnosis, age, or behaviour alone.

📋 ACP Documentation Requirements

Q: What is the RESPECT form?
A: Recommended Summary Plan for Emergency Care and Treatment — a UK-originated ACP document covering CPR decision, emergency care preferences, and care priorities. Used in many GCC hospitals.
Q: What must be documented after a GOC conversation?
A: Date/time/location; who was present; patient’s capacity status; patient’s expressed wishes; ceiling of treatment agreed; plan and review date.
Q: Where must a DNACPR form be kept?
A: Front of notes / red folder; communicated at every handover; travels with patient on transfer.

💬 Key GOC Conversation Phrases

Opening: “What matters most to you right now?” / “What do you understand about your illness?”
Exploring values: “What would a good day look like for you?” / “What are you most afraid of?”
Prognosis: “I want to be honest with you — I’m worried that [patient] is getting weaker despite treatment.”
Reframing from cure to comfort: “Our goal has shifted to keeping [patient] as comfortable as possible for as long as possible.”
Avoid: “Do you want everything done?” — replace with “What do you think your loved one would want?”

🌍 DHA / DOH / SCFHS / QCHP High-Yield ACP Questions

Q: In GCC hospitals, who typically leads ACP/GOC conversations?
A: The senior clinician (consultant), often in a joint family meeting. Nurses support communication and document outcomes. Advanced Practice Nurses may lead in some settings.
Q: A patient’s family refuses to allow disclosure of diagnosis to the patient. What is the nurse’s role?
A: Respect cultural norms while advocating for the patient’s right to information if they wish it. Explore the patient’s own wishes sensitively. Escalate to senior staff/ethics committee if conflict arises.
Q: What is the “surprise question” used in palliative care to identify patients needing ACP?
A: “Would you be surprised if this patient died in the next 12 months?” If the answer is “No” — ACP should be initiated.
Q: What is the Islamic ethical principle regarding extraordinary life-sustaining treatment?
A: Basic care (food, water, hygiene) is obligatory. Extraordinary means that are futile and cause harm are not required. Relieving suffering is a duty. Hastening death is prohibited.
Q: Clinical Frailty Scale threshold for initiating ACP discussion?
A: CFS ≥5 (Mildly Frail — requires help with heavy housework; slows on stairs) should prompt ACP conversation.
Quick Reference — Summary Table
TopicKey PointGCC Note
DNACPR decision-makerSenior Clinician (Consultant)Some Saudi hospitals require Director of Medical Affairs approval
RESPECT formUK ACP document; used in many GCC hospitalsCheck hospital-specific form — DHA, DOH, DHCC all may differ
MCA 2-stage testStage 1: impairment; Stage 2: functional inabilityAdopted in UAE DHA/DOH guidance; check local policy
ACP trigger: frailtyCFS ≥5Applicable across all GCC settings
CPR survival (metastatic cancer)<5% to dischargeUseful evidence for GOC conversations
GOC frameworkREMAP or VALUESVALUES may be easier to remember for exam
Interpreter ruleProfessional interpreter — never family member for consentCritical in multilingual GCC clinical environments
Organ donation — GCCPermitted in UAE; supported by Islamic scholars’ fatwasRefer to transplant coordinator; do not lead conversation if not trained
Interactive DNACPR Communication Planning Tool

Enter the patient’s clinical context to generate a personalised step-by-step communication checklist, suggested phrases, and documentation reminders.

DNACPR Communication Planning Tool
Complete the fields below. The tool generates a tailored communication guide — not a substitute for clinical judgement or hospital policy.

Communication Checklist

    📝 Documentation Reminder