Knowledge and confidence of junior medical doctors in discussing and documenting resuscitation plans: a cross‐sectional survey

Abstract

Background: A resuscitation plan is a medically authorised order to use or withhold resuscitation interventions. Absence of appropriate resuscitation orders exposes patients to the risk of invasive medical interventions that may be of questionable benefit depending on individual circumstances.Aims: To describe among junior doctors: (i) self-reported confidence discussing and completing resuscitation plans; (ii) knowledge of resuscitation policy including whether resuscitation plans are legally enforceable and key triggers for completion; and (iii) the factors associated with higher knowledge of triggers for completing resuscitation plans.Methods: A cross-sectional survey was conducted at five hospitals. Junior doctors on clinical rotation were approached at scheduled training sessions, before or after ward rounds or at change of rotation orientation days and provided with a pen-and-paper survey.Results: A total of 118 junior doctors participated. Most felt confident discussing (79%; n = 92) and documenting (87%; n = 102) resuscitation plans with patients. However, only 45% (n = 52) of doctors correctly identified that resuscitation plans are legally enforceable medical orders. On average, doctors correctly identified 6.8 (standard deviation = 1.8) out of 10 triggers for completing a resuscitation plan. Doctors aged >30 years were four times more likely to have high knowledge of triggers for completing resuscitation plans (odds ratio 4.28 (95% confidence interval 1.54-11.89); P = 0.0053). Conclusion:Most junior doctors feel confident discussing and documenting resuscitation plans. There is a need to improve knowledge about legal obligations to follow completed resuscitation plans, and about when resuscitation plans should be completed to ensure they are completed with patients who are most at risk.

Doctor’s Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis

“…Given doctors’ knowledge that AHDs are legally binding whilst ARPs are often poorly completed by junior doctors, this result was unexpected. This finding concurs with Bryant et al, 45 who found comparable concerns regarding resuscitation order processes in New South Wales (Australia). Despite participants’ concerns, they considered ARPs were more likely than patient-owned ACPs to be relevant to the hospital environment.…”

Junior medical doctors’ decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study

“…The survey included questions about resuscitation planning, advance care planning, substitute decision-making, demographic characteristics and clinical experience. (presented elsewhere) [44]. Only questions related to hypothetical vignettes are presented here.…”

“…Only questions related to hypothetical vignettes are presented here. The development of the survey has been described elsewhere [44]. Briefly, items were derived from the literature on legal aspects of ACP, previous studies by the authorship team [36,37,44,45] and legal and clinical expert opinions.…”

“…The development of the survey has been described elsewhere [44]. Briefly, items were derived from the literature on legal aspects of ACP, previous studies by the authorship team [36,37,44,45] and legal and clinical expert opinions. A panel of behavioural scientists, lawyers, emergency physicians, general physicians and nurses refined the items.…”

“…Participants self-reported their gender, age category, Aboriginal or Torres Strait Islander status, religious affiliation, number of years' experience as a doctor (post graduate year 1-4+), whether they were currently enrolled in a specialist training program (yes/no), whether they had ever participated in post-graduate courses or training about advance care planning (yes/no), and whether their medical degree was obtained in Australia or overseas. Six items explored knowledge of the legal validity of ACDs, legal authority of SDMs and treatment for patients without decision-making capacity [44].…”