Perspectives on the DNR decision process: A survey of nurses and physicians in hematology and oncology

Abstract

IntroductionIn cancer care, do-not-resuscitate (DNR) decisions are made frequently; i.e., decisions not to start the heart in the event of a cardiac arrest. A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians, e.g. concerning patient involvement and information. DNR decisions have also been reported to be unclear and documentation inconsistent.ObjectiveThe aim was to investigate how important and how likely to happen nurses and physicians considered various aspects of the DNR decision process, regarding participation, information and documentation, as well as which attributes they found most important in relation to DNR decisions.MethodsA descriptive correlational study using a web survey was conducted, including 132 nurses and 84 physicians working in hematology and oncology.ResultsAlmost half of the respondents reported it not likely that the patient would be involved in the decision on DNR, and 21% found it unimportant to inform patients of the DNR decision. Further, 57% reported that providing information to the patient was important, but only 21% stated that this was likely to happen. There were differences between nurses and physicians, especially regarding participation by and information to patients and relatives. The attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values, but a difference was found, as nurses chose patient autonomy as the most important value, while physicians rated non-maleficence as the most important value in relation to DNR decisions.ConclusionNurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so that they can develop a deeper understanding of the decisions, especially in cases where they disagree. They should also be aware that what they think is important is not always likely to happen. The organization needs to support such discussions through providing an environment that allows ethical discussions on regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.

Do-Not-Resuscitate (DNR)

“…A DNR order is the order for the healthcare professionals not to perform CPR on a patient with cardiac arrest or pulmonary arrest (cardio-respiratory arrest) [3][4][5][6][7][8]9 .…”

“…DNR orders are unique in that neither basic (heart compressions and ventilation) nor advanced (defibrillator or medicine) resuscitation is attempted 3,8 . CPR is the only medical intervention that requires an order not to perform it.…”

“…Most of the physician are not acquainted when to issue and implement DNR orders and with whom to discuss and negotiate. There is also difference of opinion among healthcare professionals 3,5 .…”

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

“…A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. A previous study reported that providing DNR information to the patient was important, but a few nurses and physicians stated that they discussed DNR with patients before issuance [2]. The better the nursing staff's knowledge and attitude towards the terminal patients' care, the more con dent they can be in discussing DNR and hospice care with terminal patients and their families [3].…”

“…The better the nursing staff's knowledge and attitude towards the terminal patients' care, the more con dent they can be in discussing DNR and hospice care with terminal patients and their families [3]. Additionally, DNR discussion should be carried out as early as possible when the patient is relatively healthy and is still able to understand its undertakings, as well as provide a reference for the terminal patient and family members to make medical decisions to provide better care [2,[4][5][6].…”