How, When and Where to Discuss Do Not Resuscitate: A Prospective Study to Compare the Perceptions and Preferences of Patients, Caregivers, and Health Care Providers in a Multidisciplinary Lung Cancer Clinic

Ahmed, Naseer; Lobchuk, Michelle; Hunter, W. M.; Johnston, Pam; Nugent, Zoann; Sharma, Ankur; Ahmed, Shahida; Sisler, Jeff

doi:10.1016/j.ijrobp.2015.07.1749

Cited by 7 publications

(9 citation statements)

References 19 publications

(21 reference statements)

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“…We employed a ‘think aloud’ process where participants were prompted to immediately verbalize their thoughts when responding to items in the investigator-developed questionnaire on DNR status and DNR discussions [ 2 ]. In response to our prompts, we were able to glean an understanding of their level of understanding, personal wishes, triggers, timing, appropriate setting, emotional experiences, appropriate health care provider, and extent of family dialogue on DNR decisions.…”

Section: Methodsmentioning

confidence: 99%

“…Interviews were audio-recorded and transcribed for interpretation and analyses of the key themes. A more detailed description of the interview process is captured in another article [ 2 ].…”

Section: Methodsmentioning

confidence: 99%

“…Do Not Resuscitate (DNR) orders are a significant part of EOL discussions [ 1 ]. We recently published a report describing perceptions and preferences of patients, their family caregivers (CGs), and their health care providers (HCP), with respect to their understanding of and the appropriate time to discuss DNR [ 2 ]. In the current article, the investigators report study findings from their cross-sectional exploration of cognitive and emotional perceptions and preferences of patients and their CGs when engaged in DNR discussions.…”

Section: Introductionmentioning

confidence: 99%

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Perceptions and Preferences of Patients with Terminal Lung Cancer and Family Caregivers about DNR

Ahmed¹,

Lobchuk²,

Hunter³

et al. 2015

Cureus

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Background: Patients with terminal lung cancer and their families are challenged and stressed with the end of life discussions. Do Not Resuscitate (DNR) orders are a critical part of such discussions.Objective: To understand the perceptions and preferences of patients with terminal lung cancer and their family caregivers around DNR discussions. .Methods: Our quantitative component consisted of a pen-and-paper questionnaire that was followed by a ‘think aloud’ process to capture perceptions of participants in response to questionnaire items. Qualitative methods included content analysis and constant comparison techniques to identify, code, and categorize primary themes arising from ‘think aloud’ responses.Results: In this pilot study, 10 patients with advanced stage lung cancer and nine family caregivers were enrolled from one tertiary cancer care centre. Three major themes and several sub-themes were identified reflecting participants’ psychosocial environment, emotional responses to DNR discussions, and suggestions to improve DNR discussions. Most of the time, both patients and caregivers perceived a supportive environment within their family unit. Some patients were uncertain about their disease extent but most had entertained thoughts about prognosis and DNR status prior to having a discussion with their physician. A range of situations stimulated the DNR discussion. Most patients were uncertain about identifying the most appropriate health care provider (HCP) for DNR discussion. While participants found DNR discussions distressing, patients maintained hope in the face of accepting a terminal diagnosis. There were mixed feelings about the reversibility of a DNR decision and concerns about the care of the patients after being stated as DNR. Participants desired their HCP to be emotionally sensitive, knowledgeable, respectful, and straightforward.Conclusions: Most participants were open about their experiences with psychosocial supports and emotional reactions and made suggestions to HCP to improve DNR discussions. Further examination in larger longitudinal studies is required to validate the observations in the current study.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perceptions and Preferences of Patients with Terminal Lung Cancer and Family Caregivers about DNR

Ahmed¹,

Lobchuk²,

Hunter³

et al. 2015

Cureus

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“…Our study showed that religious belief was directly and positively in uenced the practice toward the signing of the DNR by the family members of the terminal patients. Prior studies have shown that religious beliefs are a major factor in forming caregivers' and health care providers' viewpoints about DNR decisions [38,39]. This is because religious beliefs play an important role in the lives of many people since spiritual and religious issues are usually aroused or strengthened as patients near the end of life, as well as nurses on nursing practice behaviors toward the end of life care [27].…”

Section: Path Modeling Of Knowledge Attitude and Practicementioning

confidence: 99%

The effect of practice toward do-not-resuscitate among Taiwanese nursing staff using path modeling

Chang

Hung

et al. 2020

Preprint

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Background: Do-Not-Resuscitate (DNR) is signed to prevent patients from receiving invalid treatment at the end of life or near death. Nurses play an important role to discuss the DNR with patients or the patients’ family members. However, research focusing on the relationship between the knowledge, attitude and practice of a DNR using path modeling in nursing staff is limited. Therefore, this study aimed to elucidate the effect of path modeling on the knowledge, attitude, and practice toward DNR among the Taiwanese nursing staff.Methods: This was a cross-sectional, descriptive design using a simple random sampling. Data on demographics, knowledge, attitude, and practice as measured by the DNR inventory (KAP-DNR), Mindful Attention Awareness Scale, General Self-Efficacy Scale, and Dispositional Resilience Scale was collected. Participants were 194 nursing staff from a medical center in northern Taiwan in 2019. We performed descriptive statistics, regression analysis, and path modeling using SPSS 22.0 and set p <0.05 as the statistical significance threshold. Results: The results showed that participation in DNR signature and education related to palliative care were positive significant predictors of knowledge towards DNR. The DNR predictors toward attitude included DNR knowledge, mindfulness, self-efficacy, dispositional resilience, and religious belief of nurses. Generally, the key predictors of DNR practice were DNR attitude, dispositional resilience, and male nurses. In path modeling, we identified that self-efficacy, dispositional resilience, master’s degree, and religious belief directly influenced practices constituting DNR. Conclusion: Based on the findings of this study, it is proposed that nurses should improve their self-efficacy and dispositional resilience. Encouraging staff to undertake further education and have religious beliefs can improve the practice of DNR and provide better end of life care.

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“…The influence of religion and cultural issues on DNR decisions in Muslims countries occasionally appears in the literature (Ahmed et al., ). In the religion of Islam, there is a fundamental belief that “Whomever takes a human life, for other than murder or corruption in the earth, it is as if he has taken the life of all mankind” (Quran 5: 32).…”

Section: Introductionmentioning

confidence: 99%

Palestinian community perceptions of do‐not‐resuscitation order for terminally Ill patients: A qualitative study

Alrimawi

Saifan²,

Abdelkader

et al. 2017

Journal of Clinical Nursing

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How, When and Where to Discuss Do Not Resuscitate: A Prospective Study to Compare the Perceptions and Preferences of Patients, Caregivers, and Health Care Providers in a Multidisciplinary Lung Cancer Clinic

Cited by 7 publications

References 19 publications

Perceptions and Preferences of Patients with Terminal Lung Cancer and Family Caregivers about DNR

Perceptions and Preferences of Patients with Terminal Lung Cancer and Family Caregivers about DNR

The effect of practice toward do-not-resuscitate among Taiwanese nursing staff using path modeling

Palestinian community perceptions of do‐not‐resuscitation order for terminally Ill patients: A qualitative study

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