Are physicians on the same page about do-not-resuscitate? To examine individual physicians\u2019 influence on do-not-resuscitate decision-making: a retrospective and observational study

Yen-Yuan Chen,Ming-Tsan Lin,Yu-Chun Chiu,Kuan-Han Lin,Melany Su,Shu-Chien Huang,Tzong-Shinn Chu

doi:10.1186/s12910-019-0429-z

Abstract

BackgroundIndividual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate (DNR) orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order.MethodsThis study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order.ResultsWe found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so.ConclusionOur study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order.

Highlights

Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, influencing the practice of do-not-resuscitate (DNR) orders
We aimed to determine whether the likelihood of signing a DNR order for patients varies among individual physicians in actual clinical practice
Setting This study was conducted in closed model, surgical Intensive care unit (ICU) in a university-affiliated teaching hospital located in Northern Taiwan

Summary

Introduction

Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, influencing the practice of do-not-resuscitate (DNR) orders. While end-of-life care (EOLC) has become increasingly aggressive over the last decade [2,3,4], studies have challenged the. One form of EOLC that has received substantial legislative attention is Do-Not-Resuscitate (DNR) orders, the instruction for medical professionals not to attempt resuscitation on a patient when experiencing cardiac or respiratory arrest. In the United States, beginning in the 1970s, a series of policies and legislations were issued to address the lack of a structured decision-making process regarding cardiopulmonary resuscitation (CPR). For clearly indicating medical care provided to DNR patients, the State of Ohio established a Do-Not-Resuscitate Law in 1998, indicating two distinct protocols of DNR orders [12, 13]. Congress passed the Patient Self-Determination Act in 1990, which requires healthcare institutions to ask patients, upon admission, if they have prepared an advance directive, if they would like to place a copy in their records, and if they would like information about completing an advance directive [1]

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