Abstract
The Do-Not-Resuscitate (DNR) directive has provided a major leap in end-of-life care. To demonstrate the factors influencing physicians’ DNR decisions in King Fahd University Hospital in the Eastern Province of Saudi Arabia, 42 physicians from the medical and surgical departments of the same center were requested to participate in a cross-sectional survey.Thirty-six questionnaires were completed and returned from a total of 42 distributed among physicians, making a response rate of 85.7%. Certain diagnostic categories increase the likelihood of issuing a DNR order for a patient. Neurological (58.3%) and cardiovascular (41.7%) diseases were the highest response among other diseases in influencing physicians’ decisions. In addition, other factors like lack of comorbidities (55.5%), age (52.7%), and previous intensive care unit (ICU) admissions and resuscitation (44.4%) showed an effect on the directive decisions of DNR among investigated physicians. However, weak palliative care in the hospital (11.1%), religious beliefs (5.5%), and gender (2.7%) were the least associated factors affecting physicians’ DNR decisions.This study addresses the influencing factors of DNR orders issuance among King Fahd Hospital of the University physicians. Physicians noted that cultural standards and religious beliefs do play a role in their decision-making but had less of an effect as compared to other clinical data such as comorbidities, age, and previous ICU admissions.
Highlights
Before the introduction of Do-Not-Resuscitate (DNR) in the 1970s, cardiopulmonary resuscitation (CPR) was performed on every patient with cardiopulmonary arrest, regardless of their clinical situations and prognoses
Physicians noted that cultural standards and religious beliefs do play a role in their decision-making but had less of an effect as compared to other clinical data such as comorbidities, age, and previous intensive care unit (ICU) admissions
All of the participants agreed that DNR is legal in Saudi Arabia, 83.3% believed it to be allowed in Islam, 2.8% thought it was prohibited in Islam, and 13.9% did not know
Summary
Before the introduction of Do-Not-Resuscitate (DNR) in the 1970s, cardiopulmonary resuscitation (CPR) was performed on every patient with cardiopulmonary arrest, regardless of their clinical situations and prognoses This had inevitably resulted in unfavorable results, including the prolongation of patients suffering from terminal illnesses and increased family stress in the form of anxiety and financial burden [1]. DNR is a medical directive to withhold the patients’ cardiac and pulmonary resuscitation It was initially passed by the fatwa (Islamic ruling) issued on 30/6/1409 (1988/1989), No 12086. It states that DNR is a medical decision agreed upon by three competent physicians when the treatment is deemed futile in terminally ill patients [2]. The latest Saudi National Policy of 2017 adds some specifics to be followed but has not altered that the decision is to be carried out by the same number of physicians [2]
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