Investigating the attitude of healthcare providers, patients, and their families toward “do not resuscitate” orders in an Iranian Oncology Hospital

Abstract

Aim:The decision-making process for do-not-resuscitate (DNR) order has always been challenging. Cultural and religious issues have limited the issuance and execution of DNR orders in Iran. The purpose of this study was to assess the attitude of the nurses, physicians, patients, and their families toward the DNR order.Subjects and Methods:In this cross-sectional study, 343 participants (201 patients, 95 family members, and 47 healthcare providers) from Omid Oncology Hospital, Mashhad, Iran, were surveyed during 2017–2018. All the participants were asked to fill in a checklist of demographic information and a validated questionnaire about their attitude toward DNR orders after giving consent. The data were analyzed using SPSS software and values of P < 0.05 were considered statistically significant.Results:Overall, 201 patients and 95 of their family members, as well as 47 healthcare providers (doctors and nurses), were surveyed. The mean age of participants was 48.75 ± 15.62 years. The attitude of the participants regarding the DNR order was significantly different in 10 of the 11 items (P ≤ 0.005). Among the three groups of participants, healthcare providers showed the most positive attitude regarding the DNR order. The attitude of participants regarding the DNR orders was significantly associated with age, occupation status, residential place, educational status, and income level (P < 0.05).Conclusions:Various factors, such as economic status, level of education, place of residence, and gender, can be effective on decision-making regarding the DNR orders. Unified and sustained education regarding moral and cultural issues can be helpful in the reconciliation of the attitudes between caregivers and patients.

Health Care Providers’ Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran

“…In this context, Jure et al (2019) found that gender is one of the elements impacting decisions about autonomy, patient rights, and resuscitation commencement or prevention (Jure et al, 2019). In addition, Fayyazi Bordbar et al (2019) found that gender is a significant factor in deciding on a DNR order, with male caregivers and family members of cancer patients having a more favorable attitude toward the DNR order (Bordbar et al, 2019). In contrast to the current findings, Fallahi et al, 2016 investigated Iranian physicians’ perceptions toward the DNR order and discovered that gender was not a key factor in deciding on a DNR order, and there was no association between gender and attitudes toward a DNR order (Fallahi et al, 2016).…”

Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent

“…In a study of health care providers’ attitudes toward DNR consent, 57% of the respondents indicated that they believed that providing enough information regarding DNR consent to patients was important. However, the execution rate was only 21% [ 14 , 23 ].…”

“…Moreover, older adult patients with chronic diseases often exhibit poor responses to CPR, which limit their ability to participate in DNR decision-making [ 25 , 26 , 27 , 28 ]. Studies have demonstrated that various factors affect DNR decision-making, including economic status, suggestions from nurses or physicians, education level, place of residence of family members, and sex [ 9 , 14 , 15 ]. A tool for evaluating the extent of the reversibility of a patient’s illness that can be used before the patient is admitted to the hospital [ 29 ] would be helpful in preparing for DNR discussions.…”

“…DNR decisions become inevitable in many end-of-life scenarios [ 15 ]; thus, the provision of correct and balanced medical information to patients and their families is a crucial concern in enhancing the quality of intensive care [ 26 ]. In 2019, Pettersson et al argued that hospitals must provide an appropriate environment for palliative care discussions, enable patients and their relatives to obtain more DNR information from the medical team, and guide all parties toward the optimal decision for the patient [ 14 , 23 ]. Studies have suggested that the failure of DNR policy may be attributed to physicians lacking communication skills and sufficient information to discuss DNR consent with patients.…”

“…In situations where patients may not be able to make their own decisions and participate in treatment decision-making, family members have primary authority [ 10 , 11 , 12 , 13 ]. Insufficient information can make the decision to adopt a DNR order difficult for patients and their families [ 2 , 9 , 14 , 15 , 16 , 17 ]. In Western cultures, which tend to be more oriented toward the individual, a patient’s family members often do not directly interfere with the patient’s decisions; however, patients and their families in Western cultures are more willing to make health care decisions in advance, which improves the patient’s quality of life [ 13 , 18 ].…”