{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:48:10Z","timestamp":1782406090474,"version":"3.54.5"},"reference-count":28,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHS England","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,28]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the circumstances and contributory factors in cases where cardiopulmonary resuscitation (CPR) is administered to people with a learning disability despite a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) recommendation being in place. Limited understanding exists around why DNACPR recommendations are sometimes not followed in practice. This study aims to address this gap by examining what occurs when CPR is performed contrary to an established DNACPR recommendation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative study using inductive thematic analysis of secondary data derived from comprehensive reviews of deaths of people with a learning disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>England, deaths occurring in hospital or out of hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>21 adults (aged \u226518 years) with a learning disability who died between 2020 and 2022 and whose deaths were reviewed through the Learning from Lives and Deaths (LeDeR) programme. Cases were included where a DNACPR recommendation was in place but not followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes describe pressures to respond to an emergency, knowledge and awareness of DNACPR and decision-making processes. Two cross-cutting factors shaped how DNACPR recommendations were enacted in practice: breakdowns in information sharing and unclear or inaccessible documentation. The challenges described in each theme, compounded by the cross-cutting factors, created uncertainty and contributed to a default to life-preserving action despite active DNACPR recommendations being in place.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DNACPR recommendations for people with a learning disability are at risk of not being followed as intended in emergency contexts due to challenges in communication and documentation. These issues create uncertainty and may contribute to a default to attempt resuscitation. Improvements are needed in how DNACPR decisions are documented, shared and accessed across care settings, alongside training to support staff in interpreting and applying recommendations in complex situations, including within the legal framework of the Mental Capacity Act (2005).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107222","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:15:17Z","timestamp":1782404117000},"page":"e107222","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["\u2018An adrenaline-fueled emergency\u2019: a qualitative thematic analysis of reviews of deaths in England where DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) recommendations are not implemented for people with a learning disability"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6226-0519","authenticated-orcid":false,"given":"Christina","family":"Roberts","sequence":"first","affiliation":[{"name":"Faculty of Health, Science, Social Care and Education, Kingston University London, Kingston upon Thames, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Ditzel","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, University of Lancashire, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"White","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-9661","authenticated-orcid":false,"given":"Rory","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Strydom","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Ruck-Keene","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh","family":"Chauhan","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, University of Lancashire, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"2026062509151057000_16.6.e107222.1","unstructured":"NHS England . 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