Discrepancies among hospital physicians regarding the Do Not Attempt Resuscitation order and its interpretation

Abstract

Abstract Background A Do Not Attempt Resuscitation (DNAR) order is one of the most important medical decisions in providing adequate end-of-life care. There is variation in national and local policies of making a DNAR order in spite of the recent European guidelines. Physicians in general perceive challenges in making a DNAR order. However, possible variation across different clinical specialties is not known. Methods A link to the web-based multiple-choice questionnaire (Webropol) was sent by e-mail to all physicians and nurses working in the Tampere University Hospital special responsibility area covering a catchment area of 900,000 Finns. The questionnaire, developed by the authors, covered issues on DNAR order making, its meaning and documentation. Participants responded anonymously. Results In total, 934 subjects responded, of which 216 (23%) were physicians covering all specialties. A total of 154 (71%) of respondents were specialists and 62 (29%) were physicians in training. The responses of physicians were categorized into six categories according to clinical specialty: anesthesiology and intensive care unit (ICU), conservative departments, surgical departments, oncology, pediatrics and pediatric neurology, and psychiatry. In total, 63% of doctors in oncology and 73% in pediatric/pediatric neurology departments correctly recognized that a DNAR order relates only to cardiopulmonary resuscitation, while only 27–46% of physicians in anesthesiology or ICU, conservative and surgical departments, and psychiatry correctly recognized the meaning of DNAR. Challenges in interpreting the meaning of the DNAR order had been experienced by 62% of physicians in anesthesiology/ICU, 66% in conservative departments and 49% in operative departments, whereas frequencies were lower in oncological, pediatric/pediatric neurology and psychiatric departments (36–38%). Training in making a DNAR order was considered adequate by 66% of physicians in anesthesiology, 87% in oncology, and by only 20–56% of doctors in other specialties. Conclusion Our findings show specialty-related variation among hospital physicians in the interpretation of the scope of the DNAR order and who should be included in the decision-making process. There is need for further training in making a DNAR order in major hospital specialties.