Care of terminally-ill patients: an opinion survey among critical care healthcare providers in the Middle East

Abstract

Background: Modern medicine has allowed physicians to support the dying terminally-ill patient with artificial means. However, a common dilemma faced by physicians in general, and intensivist in particular is when to limit or withdraw aggressive intervention. Objective: To study the effect of training background and seniority on Do-not to resuscitate (DNR) decisions in the Middle East. Methods: Anonymous questionnaire sent to members of the Pan Arab Society of Critical Care. Results: The response rate was 46.2%. Most of the responders were Muslim (86%) and consultants (70.9%). Majority of the responders were trained in western countries. Religion played a major role in 59.3% for making the DNR decision. DNR was considered equivalent to comfort care by 39.5%. In a futile case scenario, Do Not Escalate Therapy was preferred (54.7%). The likelihood of a patient, once labeled DNR, being clinically neglected was a concern among 46.5%. Admission of DNR patients to the ICU was acceptable for 47.7%. Almost one-half of the responders (46.5%) wanted physicians to have the ultimate authority in the DNR decision. Training background was a significant factor affecting the interpretation of the term no code DNR (P< 0.008). Conclusion: Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of terminally-ill patients. However, DNR is considered equivalent to comfort care among majority of Middle Eastern trained physicians.

<p>Pediatricians’ Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review</p>

“…In a survey among critical care health-care providers in the Middle East, 46.5% of responders expressed their concern that patients were likely to be clinically neglected once labeled as DNR. 29 Stevenson et al 30 showed that residents appear to assume that patients with DNR orders would prefer not to receive other interventions, so potentially beneficial care may be withheld against the patient's wishes. Beach et al 31 found that the presence of a DNR order may affect a physician's willingness to order a variety of interventions/treatments not related to CPR (such as taking blood cultures, putting in a central line, or referral to an ICU).…”

A systematic review of religious beliefs about major end-of-life issues in the five major world religions

“…These differences were significant after controlling for religious importance and attendance (Wolenberg et al, 2013), and the least religious physicians were less likely to oppose withholding or withdrawing ANH. Another study showed that the majority of Muslim physicians in the Middle East believe in feeding DNR patients (ur Rahman et al, 2013). …”

“…More than half of Muslim physicians surveyed in the Middle East consider the ability to pray an extremely important aspect of EoL care (ur Rahman et al, 2013). However, Khalid et al (2013) found that there is minimal involvement of Muslim chaplains or social workers in EoL discussions in the region.…”

The concept of do not resuscitate for students in King Abdulaziz University Hospital

“…Usually, DNR decisions are ordered by the physicians, but a study in Denmark suggested that the physicians and the patients should make the final decisions together. [7] In Saudi Arabia, there is Islamic Fatwa which is considered to be an essential part decision-making process because different systems and the authorities in Saudi Arabia follow the Islamic law. The Islamic opinion on DNR was published in 1988.…”