To resuscitate or not: a dilemma in terminal cancer care

Abstract

One of the difficult dilemmas in terminal care is the decision on whether to start or withhold cardiopulmonary resuscitation (CPR). Is this decision made on purely medical grounds, or is it also influenced by the physician's personal characteristics or education? The aim of this study was to look at factors affecting this decision. A questionnaire was sent out to a stratified sample of 1180 Finnish doctors. The response rate was 62%. The physicians were asked whether they would (a) start CPR or (b) withhold CPR in a scenario describing the unexpected death of a young terminal cancer patient. Data were also collected on demographics, post-graduate training, experience of terminal care, general life values and attitudes, and experiences of severe illness in the family. The proportion of surgeons, internists, GPs and oncologists who said they would have started CPR was 16, 10, 19 and 14%, respectively. Among physicians aged under 35 years, from 35 to 49 years and over 49 years, the proportions of physicians choosing active CPR were 29, 14 and 13%, respectively ( P<0.001). As for those with personal experience of terminal care, 13% indicated they would have started CPR compared with 23% of those who had no experience ( P<0.01). Those who made a decision in favour of CPR showed a significantly ( P<0.001) more negative attitude to withdrawing life-sustaining treatment and valued length of life to a much greater extent ( P<0.01).