End-of-life scenarios test your empathy, communication skills, and understanding of the ethical and legal frameworks around death and dying. These are emotionally charged topics where the panel is looking for sensitivity and compassion alongside clinical knowledge.
DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
Key facts for your interview answer: a DNACPR decision is a clinical decision made by the senior clinician responsible for the patient’s care. It is NOT a decision that requires patient or family consent — however, there is a strong expectation that the decision is discussed with the patient (if they have capacity) and their family, and their views should be taken into account. The legal framework was clarified by the Court of Appeal in Tracey v Cambridge University Hospitals NHS Foundation Trust (2014), which established that there is a presumption that patients should be consulted about DNACPR decisions unless the clinician considers that discussion would cause the patient physical or psychological harm. In most NHS trusts, DNACPR is now documented using the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process, which is a broader advance care planning tool that includes DNACPR but also documents the patient’s overall treatment preferences and goals of care. A DNACPR decision does NOT mean “do not treat” — it only applies to CPR. All other appropriate medical treatment should continue.
Breaking Bad News — The SPIKES Framework
The SPIKES framework (Buckman, 2005) is the most widely used structure for breaking bad news in UK medical practice:
- S — Setting up: Find a private, quiet room. Sit down. Ensure you will not be interrupted. Have tissues available. Ask the patient if they would like anyone else present.
- P — Perception: Find out what the patient already knows or suspects. “What have you been told so far?” or “What is your understanding of why we did these tests?” This allows you to pitch your explanation at the right level and correct any misunderstandings.
- I — Invitation: Ask the patient how much information they want. “Would you like me to go through the results in detail, or would you prefer me to give you the main points?” Some patients want full information; others prefer a summary initially.
- K — Knowledge: Deliver the news clearly and compassionately. Use a “warning shot” before giving the bad news: “I’m afraid the results are not what we were hoping for.” Use plain language, not medical jargon. Deliver information in small chunks and pause to allow the patient to absorb each piece.
- E — Emotions: Acknowledge and validate the patient’s emotional response. Allow silence. Do not rush to fill pauses. “I can see this is very difficult news. Take all the time you need.”
- S — Strategy and Summary: Discuss next steps, treatment options, and a plan. Arrange follow-up. Offer written information. Ensure the patient knows who to contact if they have questions. “We will arrange a follow-up appointment for next week so we can discuss the next steps in more detail when you have had time to process this.”
Family disagreement: If a family disagrees with the clinical team’s recommendation (e.g., withdrawal of active treatment), your answer should include: empathetic communication, a family meeting involving the senior clinician, clear explanation of the clinical reasoning, involving the hospital chaplain or cultural/spiritual support if appropriate, seeking a second medical opinion if requested, and if disagreement persists, involving the trust’s clinical ethics committee. Ultimately, clinical decisions rest with the medical team, but every effort should be made to reach a consensus with the family.