The Perspectives of the General Population and Relatives of Cancer Patients with Respect to the Do-Not-Resuscitate Order

Abstract

Background A do-not-resuscitate (DNR) order is a medical decision that instructs healthcare providers to withhold cardiopulmonary resuscitations (CPR) to patients in case of cardiopulmonary arrest in respect to their wishes. In Saudi Arabia, the decision is usually made by physicians based on the Fatwa number 12086 regardless of the patients’ or their families' desires. Assessing the knowledge, perception, and attitude of Saudi family members towards this medical decision may help guide medical practitioners to make decisions that are legally and ethically acceptable for the patients and their family. Therefore, this study aimed to assess their knowledge, perception, and attitude about DNR decisions and to determine demographic variables that affect their attitude towards DNR decisions. Method This cross-sectional study was conducted from December 2017 to January 2018 utilizing survey distribution through emails and different social media outlets including Facebook, Twitter, Pinterest, and LinkedIn. A self-administered questionnaire was employed to elicit responses regarding knowledge, perception, and attitude towards DNR decisions. Statistical Package for the Social Sciences Windows version 17 (SPSS v.17) (IBM Corporation, USA) was used for data management and analysis. Result Of the 1882 participants who filled the questionnaire, only 1693 participants were eligible as the study sample population and were included in the final data analysis. Most of the participants were from the Makkah region (72.2%) and were mainly from the general population (61.66%). Participants were mainly females (66%) and within the median age of 30 years (IQR: 21). As expected, participants who had heard about the DNR practice were from the medical field (58.6%) and they were mainly distant relatives. Almost 76% of the participants had two to four incorrect answers about the DNR practice, and it indicated that participants have inadequate knowledge about a DNR order. Most of the participants (43.2%) refused to be on a DNR order if they were diagnosed with a terminal illness. However, most participants (69.9%) wanted to have an involvement in the decision-making of being on a DNR order. In terms of willingness to understand and learn about the DNR decision, 1475 (87.1%) of the participants wanted to learn more about the DNR practice. Being a relative of a terminally ill cancer patient did not have a significant effect on the knowledge and perceptions of participants about being on a DNR order. However, having a background in medicine was found to be significantly associated with their acceptance to be on a DNR order. The knowledge score regarding DNR was found to be significantly associated with higher acceptance towards DNR orders. Conclusion The majority of participants had a lack of knowledge about the DNR practice. Their religion’s concept of hope and virtue is considered as the major reason for their DNR order refusal. However, proper education about...

Knowledge gaps, attitudes, and practices regarding end-of-life medical care among physicians in an academic medical center

“…As illustrated in Figure 1, 40.7% of the physicians stated that the patient should be authorized to issue a DNR order, followed by the treating physician and the patient's family (21.2% and 16.3%, respectively). These findings surprisingly contrasted with other studies investigating physicians' perspectives regarding DNR in the Middle East and concluded that treating physicians should be the ultimate party in issuing DNR orders [19,25,29]. Nevertheless, the treating physician should play a critical role in the process of DNR decisionmaking; however, the patient or patient's surrogate should be involved in such processes.…”

Current state of ethical challenges reported in Saudi Arabia: a systematic review & bibliometric analysis from 2010 to 2021

“…Studies in which patients were included as a target population reported a lack of knowledge of the medical conditions for DNR practice [ 62 , 65 , 66 , 68 , 69 ]. Patients expressed a will to participate in discussions with doctors on planning end-of-life care and making their own decisions.…”

“…Patients expressed a will to participate in discussions with doctors on planning end-of-life care and making their own decisions. Patients with higher levels of education, medical background, and knowledge of DNR were more likely to agree with DNR practice [ 62 , 65 , 66 , 68 , 69 ].…”

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

“…DNR discussions among health care providers, patients and their families do not occur frequently enough [ 2 , 24 ] and often occur later than is appropriate; accordingly, health care providers should prioritize early discussion of a patient’s wishes regarding DNR and related considerations [ 9 , 24 ]. 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 ].…”