Medical Care Plan Research Articles

Association Between Current Medical Decision-Making Participation Self-Efficacy and Advance Care Planning Engagement Among Older Adults: Baseline Findings from a Nationwide Longitudinal Cohort Study.

Background and Objectives: Misconceptions of and cultural differences in aging influence older adults' medical decision-making self-efficacy and engagement in advance care planning (ACP). This study aims to investigate the association between current medical decision-making participation self-efficacy and ACP engagement among older individuals receiving home-based medical care (HBMC) in Taiwan. Design: Baseline data analysis of a nationwide cohort study. Setting and Participants: Patients aged ≥50 years who had been consistently receiving HBMC for > two months between November 2019 and December 2022 were recruited. Study recruitment took place at six hospitals and 12 community home care institutions. Measurement and Analysis: A structured questionnaire was used to collect data on sociodemographic characteristics, decision-making participation self-efficacy, and ACP engagement. Descriptive, stratified, and multivariate logistic regression analyses were performed. Results: In total, 408 HBMC recipients were enrolled (average age: 80.4 years; 55% women). The respondents reported moderate decision-making participation self-efficacy but low ACP engagement. In light of the transtheoretical model of behavior change, participants with moderate or high self-efficacy had a significantly higher chance of reaching the "contemplation stage" for ACP decisions (odds ratio or OR 4.06-27.13). Participants were more likely to reach the "preparation and action stages" for ACP decisions only when they had high self-efficacy (OR 2.76-14.73). Conclusions: Although participants with better current medical decision-making self-efficacy were more likely to contemplate ACP, many did not take action beyond appointing a medical surrogate(s). Strategies to enhance decisional self-efficacy, thereby increasing timely ACP discussions among older adults in home settings in Chinese culture, are warranted. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.

Healthcare spending and out-of-pocket burden for working-aged adults after a cancer diagnosis.

16 Background: The cost of cancer care rose dramatically over the past decades, increasing the financial burden on patients. However, current estimates of healthcare spending and out-of-pocket burden rely heavily on data from older populations that may not reflect contemporary treatment patterns in working-aged adults or variation in type of insurance coverage. Methods: We used the 2012-2021 Colorado Central Cancer Registry linked to the All-Payer Claims Database to identify adults aged 22-63 years newly diagnosed with invasive cancer who were consecutively enrolled on the same insurance type or the month of diagnosis and 6 months after (or until death). We used quantile regression to adjust spending by age and sex and report median insurer reimbursements for medical care and pharmacy costs and out-of-pocket spending (copays, deductibles, coinsurance) for the most common insurance and cancer types. Results: Among 31,179 individuals newly diagnosed with cancer, the median total spending six months after diagnosis across all cancers ranged from 59,022 for those insured by private non-health maintenance organization (HMO) plans to 26,887 for those enrolled on Medicaid and 19,152 for those on Medicare Advantage (MA) plans (Table). The majority of spending was for medical care. Among individuals insured by private non-HMO plans, those with lymphoma had the highest total median spending at 130,408, followed by lung (94,207), breast ($87,830), and leukemia ($82,445). Although total spending was markedly lower among those insured by Medicaid, among this group, individuals with leukemia ($50,399) and lymphoma (48,747) experienced the highest median spending. Out-of-pocket spending was substantially higher for those insured by private non-HMO plans (3,582 or approximately 511/month) across all cancer types, and highest for lymphomas (3,966) and lung ($3,455) cancers. Conclusions: Total healthcare spending in the 6 months after a cancer diagnosis is considerable in the working-age population, with a high out-of-pocket burden for patients with private non-HMO coverage. Median spending in 6 months after cancer diagnosis (in 2021 dollars), adjusted for age and sex. Medical Care Plan Payments* Pharmacy Plan Payments* Out of Pocket Spending* Total Spending* Overall(n=31,793) Dual Medicaid/Medicare $24,081 $1,793 $19 $28,806 Medicaid $23,415 $641 $13 $26,887 Medicare TM $20,698 $797 $3,275 $27,028 Medicare MA $14,227 $570 $2,069 $19,152 Private non-HMO $51,196 $274 $3,582 $59,022 Private HMO $36,414 $219 $2,622 $42,916 Median costs significantly different across all payers, p<0.05.

Electronic health record system use and documentation burden of acute and critical care nurse clinicians: a mixed-methods study.

Examine electronic health record (EHR) use and factors contributing to documentation burden in acute and critical care nurses. A mixed-methods design was used guided by Unified Theory of Acceptance and Use of Technology. Key EHR components included, Flowsheets, Medication Administration Records (MAR), Care Plan, Notes, and Navigators. We first identified 5 units with the highest documentation burden in 1 university hospital through EHR log file analyses. Four nurses per unit were recruited and engaged in interviews and surveys designed to examine their perceptions of ease of use and usefulness of the 5 EHR components. A combination of inductive/deductive coding was used for qualitative data analysis. Nurses acknowledged the importance of documentation for patient care, yet perceived the required documentation as burdensome with levels varying across the 5 components. Factors contributing to burden included non-EHR issues (patient-to-nurse staffing ratios; patient acuity; suboptimal time management) and EHR usability issues related to design/features. Flowsheets, Care Plan, and Navigators were found to be below acceptable usability and contributed to more burden compared to MAR and Notes. The most troublesome EHR usability issues were data redundancy, poor workflow navigation, and cumbersome data entry based on unit type. Overall, we used quantitative and qualitative data to highlight challenges with current nursing documentation features in the EHR that contribute to documentation burden. Differences in perceived usability across the EHR documentation components were driven by multiple factors, such as non-alignment with workflows and amount of duplication of prior data entries. Nurses offered several recommendations for improving the EHR, including minimizing redundant or excessive data entry requirements, providing visual cues (eg, clear error messages, highlighting areas where missing or incorrect information are), and integrating decision support. Our study generated evidence for nurse EHR use and specific documentation usability issues contributing to burden. Findings can inform the development of solutions for enhancing multi-component EHR usability that accommodates the unique workflow of nurses. Documentation strategies designed to improve nurse working conditions should include non-EHR factors as they also contribute to documentation burden.

A nursing note-aware deep neural network for predicting mortality risk after hospital discharge

BackgroundICU readmissions and post-discharge mortality pose significant challenges. Previous studies used EHRs and machine learning models, but mostly focused on structured data. Nursing records contain crucial unstructured information, but their utilization is challenging. Natural language processing (NLP) can extract structured features from clinical text. This study proposes the Crucial Nursing Description Extractor (CNDE) to predict post-ICU discharge mortality rates and identify high-risk patients for unplanned readmission by analyzing electronic nursing records. ObjectiveDeveloped a deep neural network (NurnaNet) with the ability to perceive nursing records, combined with a bio-clinical medicine pre-trained language model (BioClinicalBERT) to analyze the electronic health records (EHRs) in the MIMIC III dataset to predict the death of patients within six month and two year risk. DesignA cohort and system development design was used. Setting(s)Based on data extracted from MIMIC-III, a database of critically ill in the US between 2001 and 2012, the results were analyzed. ParticipantsWe calculated patients' age using admission time and date of birth information from the MIMIC dataset. Patients under 18 or over 89 years old, or who died in the hospital, were excluded. We analyzed 16,973 nursing records from patients' ICU stays. MethodsWe have developed a technology called the Crucial Nursing Description Extractor (CNDE), which extracts key content from text. We use the logarithmic likelihood ratio to extract keywords and combine BioClinicalBERT. We predict the survival of discharged patients after six months and two years and evaluate the performance of the model using precision, recall, the F1-score, the receiver operating characteristic curve (ROC curve), the area under the curve (AUC), and the precision–recall curve (PR curve). ResultsThe research findings indicate that NurnaNet achieved good F1-scores (0.67030, 0.70874) within six months and two years. Compared to using BioClinicalBERT alone, there was an improvement in performance of 2.05 % and 1.08 % for predictions within six months and two years, respectively. ConclusionsCNDE can effectively reduce long-form records and extract key content. NurnaNet has a good F1-score in analyzing the data of nursing records, which helps to identify the risk of death of patients after leaving the hospital and adjust the regular follow-up and treatment plan of relevant medical care as soon as possible.

Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update).

Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.

Microduplication and Microdeletion Syndromes Diagnosed Prenatally Using Single Nucleotide Polymorphism Array.

We present a series of microdeletion and microduplication syndromes (MMSs) observed in our clinical practice over a three-year period from 2020 to 2023. Microdeletion and microduplication syndromes, characterized by chromosomal deletions or duplications of less than five megabases, pose challenges in terms of diagnosis, especially prenatal and clinical management. Clinically, MMSs encompass a broad spectrum of manifestations, ranging from intellectual disability and developmental delays to congenital anomalies, facial dysmorphisms, and neurobehavioral abnormalities. Notable examples include well-characterized syndromes such as DiGeorge syndrome (22q11.2 deletion), Prader-Willi syndrome (15q11-q13 deletion), and Williams syndrome (7q11 deletion). Our study focuses on the genetic foundations and prenatal ultrasound findings of these syndromes, with an emphasis on cases associated with intellectual disability. Using SNP array technology, we delve into the evolving landscape of diagnostic methods, providing a nuanced understanding of copy number variations (CNVs) and their implications. Prenatal diagnosis allows for the early detection of MMSs, enabling parents and healthcare providers to make informed decisions about the pregnancy and plan for appropriate medical care and interventions. Beyond theoretical considerations, our article bridges the gap between research and practical application by offering insights derived from clinical cases. Through the presentation of specific cases, we aim to contribute valuable data to the broader discourse on MMSs, fostering knowledge exchange and enhancing the medical community's awareness of these complex genetic conditions.

Patient and Medical Unit Staff Experiences of Proactive and Integrated Consultation-Liaison Psychiatry in The HOME Study: A Qualitative Investigation

Consultation-liaison (C-L) psychiatry services aim to help general hospital staff provide better care for their patients. Recently, many inpatient C-L psychiatry services have adopted proactive and integrated approaches to achieve this aim. Despite these developments, there have been no interview-based studies of patients' and staff members' experiences of the new approaches. To gain an in-depth understanding of patients' and medical unit staff members' experiences of a proactive and integrated C-L psychiatry service for older medical inpatients (Proactive Integrated C-L Psychiatry [PICLP]). We conducted an interview-based qualitative study with thematic analysis. The participants were patients and staff who had experienced PICLP during The HOME Study, a randomized trial that evaluated PICLP in 24 medical units of three UK general hospitals. We conducted 97 interviews: 43 with patients or their proxies (family members who were interviewed on behalf of patients with significant cognitive impairment) and 54 with staff members of all relevant disciplines. Patients and staff both described how PICLP was a helpful addition to medical care and discharge planning. It enhanced the medical unit team's ability to address psychological, psychiatric, and social needs and provide patient-centered care. They welcomed proactive biopsychosocial assessments and the broader perspective that these offered on patients' complex problems. They also valued the integration of C-L psychiatrists into the unit teams and their daily contact with them. For patients, it fostered a therapeutic relationship and helped them to be more engaged in decisions about their medical care and discharge planning. For staff, it enabled ready access to psychiatric expertise and training opportunities. The few reported experiences of PICLP being unhelpful were mainly about the greater number of clinicians involved in patients' care and a lack of clarity about professional roles in the integrated team. We found that older inpatients and medical unit staff experienced PICLP as both acceptable and generally helpful. Our findings add to the existing evidence for the benefits of proactive and integrated C-L psychiatry services.

Japan's healthcare delivery system: From its historical evolution to the challenges of a super-aged society.

Although Japan's healthcare delivery system is highly regarded internationally, the COVID-19 pandemic has exposed its structural problems. Behind these issues lies a history of medical care provisions supported mainly by an unrestricted, "free labeling" system, and independently financed private hospitals. In addition, patients have a high degree of freedom of choice under the Japanese medical insurance system, making it difficult to provide comprehensive and continuous health management from initial diagnosis and treatment (primary care), specialized treatment, to supporting a return to home, providing nursing care and lifestyle support. As Japan becomes a "super-aged" society with individuals over 65 making up over 30% of the population, the nature of medical care will have to undergo major changes. Medical care's basic function must still be the treatment and cure of patients, but the system will also have to provide support. That means conceiving of care in a way that treats a person's life with dignity and does not sacrifice life for treatment. The implementation of a family doctor function and the clarification of the functions and roles of small and medium-sized community-based hospitals that support this function, as well as the establishment of a community comprehensive care network with multidisciplinary cooperation that goes beyond medical care, should also be set forth in future regional medical care plans.

Synchronous Primary Synovial Chondromatosis of the Hip: An Integrated Perspective on Physiotherapeutic Support.

Primary synovial chondromatosis of the hip is a rare joint condition characterized by the abnormal proliferation of cartilaginous tissue within the synovial membrane, which leads to the formation of clusters of chondrocytes floating in the joint space. This commentary provides a comprehensive overview of the pathology, including symptoms, diagnosis, treatment options and long-term management. Patients with primary synovial chondromatosis complaint pain and functional impairment, together with a peculiar joint popping sensation during movement, so determining early disability. The early treatment can lead to better clinical outcomes, with increased preservation of joint function and reduced risk of long-term disability, but strictly depend on symptoms acknowledgement and proper imaging interpretation. As a chronic pathology, surgical approach must necessarily be part of a larger medical and rehabilitative care planning, with long period follow-up. Multidisciplinary team management, with the active involvement of the patient is pivotal in improving the clinical outcomes and quality of life.

Dispatch of replacement doctors from core hospitals to rural clinics in Japan.

Core hospitals play an important role in rural healthcare, and the dispatch of replacement doctors (DRD) from core hospitals to rural clinics is included in medical care plans at the prefectural level in Japan. The conditions of DRD implementation in core hospitals (n=345) were observed using national data from 2022. DRD was present in 101 (29.3%) core hospitals. A greater number of doctors per 100 beds (median: 16.7) was observed when DRD was present than when it was absent (median: 11.0; P<0.05). More studies are warranted regarding the number of doctors and their functions in core hospitals to ensure DRD.

"Eat Enough"-A nurse-led intervention to enhance hospitalized older adults' protein and energy nutrition.

To develop an intervention enhancing hospitalized older adults' nutrition. For the first time, a mixed-methods design with data triangulation was applied according to the six-step model of Corry etal. to elaborate on a complex nursing intervention in the form of a logic model. Patients who were aged ≥80 years and hospitalized for at least 5 days were included. Sample size for quantitative practice analysis was 135 older adults, whereas 22 older inpatients participated in interviews and observations for needs analysis and generated data for key principles. The intervention "Eat Enough" encompasses nursing team culture and comprises six actionable targets to deliver needs-based support and reach required protein and energy intake for hospitalized older adults by sensitizing nurses and the interprofessional team. Facilitating nutritional intake would be supported by an advanced practice nurse who considers the medical and nursing care plan and therapy. The intervention "Eat Enough" demonstrates that nurses play a key role in interprofessional teams to enhance older adults' nutrition in hospital. The pipeline model displays how the actionable targets can be achieved, and how awareness raising can influence the context-leading to raised calories and protein requirement coverages and shorter length of stay. By identifying risk factors of malnutrition and strengthening nurses' responsibilities, the intervention "Eat Enough" could significantly enhance nutrition among hospitalized older adults. However, the logic model should be tested and implemented in future research.

Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update).

Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.

Organizational and economic aspects of standardization of processes in the healthcare system

Introduction. Nowadays standardization is a necessary tool for timely response to challenges and changes, the basis for the work on patient safety, contributes to the control of staff performance, minimizes the risks of medical care.&#x0D; Objective. to reveal the managing and economic aspects of standardization of processes in the healthcare system and the correctness of the use of existing regulatory documents as an algorithm for the main processes at the level of structure, at the level of process, at the level of result.&#x0D; Materials and methods. By conducting surveys and in-depth interviews, various opinions on the standards of medical care of various interviewed groups were collected: undergraduates of the HSE course “Management and Economics of Healthcare”, as well as groups of territorial fund of compulsory medical insurance medical experts and “high-level” experts. &#x0D; Results. The materials of the sociological survey showed a lack of knowledge, uncertainty and unpreparedness of respondents on the application of standards in the planning and provision of medical care, which indicates a lack of understanding of the use of standardization mechanisms in improving medical care. At the same time, in-depth interviews with “high-level” experts show this management tool to operate.&#x0D; Limitations. The research materials are limited to the results of a survey of two groups of respondents &#x0D; (78 people) conducted over the period from 09.2022 to 01.2023.&#x0D; Conclusion. The standards can be successfully used in medical care planning, pricing, examinations, as well as training and training of medical personnel. In this regard, it should be concluded that there is a need for further training on the issues of professional development of a wide range of healthcare managers, as well as in the process of training specialists at all levels. As part of the recommendations, it is advisable to provide training for medical personnel on standardization issues, including connection with the examination of the quality and safety of medical care. To develop a methodological approach to improve and use the principle of standardization in the management and provision of medical care.

Advance care planning among older adults in Belgium with Turkish backgrounds and palliative care needs: A qualitative interview study

BackgroundData on advance care planning (ACP) among migrants in Europe is lacking. Research has shown that few older migrants in the United States perform ACP due to healthcare system distrust, collectivistic values and spirituality/religion.ObjectivesTo explore the ACP knowledge and perspectives of older Turkish-origin adults in Belgium requiring palliative care.MethodGeneral practitioners (GPs) in Brussels and Antwerp recruited Turkish-origin participants aged ≥ 65 years with palliative care eligibility for this qualitative study. A GP conducted semi-structured interviews in Turkish in respondents’ homes between May 2019 and February 2022 using a topic guide. Two researchers performed combined inductive/deductive thematic data analysis.ResultsAll 15 interviewees (average age, 79 years) lacked ACP awareness and information. Some had discussed specific end-of-life preferences (e.g. care location, burial place) with family. Still, many did not feel the need to discuss future healthcare preferences, due mainly to trust in God and family for caretaking and decision-making. Some respondents viewed ACP discussions as applicable, relieving the burden on family and enabling proactive addressing of ‘what if’ questions. Self-identified ACP barriers were fear of making wrong decisions, ‘living in the moment’ and difficulty discussing death. Facilitators were obtaining sufficient ACP information and recent family illness or death.ConclusionOur sample of Turkish-origin older adults in Belgium requiring palliative care lacked ACP knowledge. Our findings suggest that their lack of engagement in discussing end-of-life medical care planning was linked to their family dynamics and religion. The findings have implications for healthcare providers to ethnic-minority groups.

Medical Care Management Based on Disaster Medicine for the Triathlon Events at the XXXII Olympiad and Tokyo 2020 Paralympic Games.

Planning the medical services for the triathlon competition at the 2020 Tokyo Olympic and Paralympic Games was predicted to be challenging because of possible last-minute changes related to the COVID-19 pandemic and abnormally high temperatures. Therefore, event planners organized and executed a disaster medical care plan, a plan for providing care during emergencies. Based on the basic medical plan for all venues provided by the Tokyo 2020 Organizing Committee, planners for the triathlon venue prepared a medical care plan according to the CSCATTT principles: Command and control, Safety, Communication, Assessment, Treatment, Triage, and Transport. After the event, planners evaluated the number of COVID-19, heatstroke, and injury cases at the venue. The events were conducted without spectators in July and August 2022 because at the last minute, planners held the event without spectators. The triathlon competition involved 638 individuals, including athletes and staff. In total, 7 cases of injuries, 3 cases of mild heatstroke, and 13 other cases were reported, with only 2 requiring emergency transportation. No cases of COVID-19 were reported from the triathlon venue, including during the observation period after the event. This medical plan was effective in preventing heatstroke and COVID-19 cases during the big event. Efficiently and effectively responding to various situations is possible in a shorter period by planning large-scale medical services for such special circumstances according to CSCATTT, a principle of disaster medical care.

Sociodemographic and clinical characteristics and access to health care in patients with spinal muscular atrophy in Argentina.

The FAME registry gathers the majority of patients with SMA in Argentina. From it, the clinical, sociodemographic and access to treatment characteristics were analyzed in 322 patients (range 8 months-61 years) included from 2008 to 2021. Important data were obtained for the planning of medical care of these patients such as: similar distribution of patient care in public and private hospitals, time gap between onset of symptoms and diagnoses, low level of completion of SMN2 copy count, estimate of 16 new diagnoses per year between 2014 and 2018, and 68% of patient in specific pharmacological treatment.

Surgical Casualty Care inContested Distributed Maritime Operations: Lessons Learned From the Falklands War.

The Falklands Campaign was fought a significant distance from the home base of the British Fleet. The planning and delivery of medical care during this campaign can provide significant lessons for strategic medical planning in other far spread geographic locations, including the Indo-Pacific region. Consideration of doctrine, including Role 1-4 facilities and the golden hour, may need to be reconsidered in light of changing scenarios. New concepts such as the "90-in-90" and "3-in-3" are also discussed as a framework for future planning in the U.S. Indo-Pacific Command area of responsibility.

Pediatric Medical Traumatic Stress and Trauma-Informed Care in Pediatric Chronic Illness: A Healthcare Provider Survey

To inform approaches to pediatric medical traumatic stress (PMTS) by exploring providers' (1) perception of the impact of PMTS on the medical care of patients with pediatric-onset chronic illnesses, (2) self-reported competencies and practices of PMTS prevention, treatment, and counseling, and (3) perception of the barriers influencing the adoption of these practices. A convenience sample of multidisciplinary healthcare providers was recruited through a multimodal recruitment strategy to participate in an electronic survey adapted from the Trauma-Informed Care Provider Survey. Among participants (n=304), 99% agreed that PMTS impacts patient health. Participants report altering medical care plans due to PMTS, including deferring or stopping treatments (n=98 [32%]) and changing medication regimens (n=88 [29%]). Sixty-eight percent (n=208) report negative impact of PMTS on patient implementation of medical care plans, including medication nonadherence (n=153 [50%]) and missed appointments (n=119 [39%]). Although participants agreed it is their job to decrease patient stress (n=292 [96%]) and perform PMTS assessments (n=268 [88%]), few practiced PMTS-focused trauma informed care. Systems-level barriers to practice included insufficient training, absent clinical workflows, and lack of access to mental health experts. Our findings have helped inform a conceptual framework for understanding the relationship between PMTS and health outcomes. Systems-level opportunities to optimize PMTS-focused trauma-informed care include (1) dissemination of provider training, (2) integrated workflows for PMTS mitigation, and (3) enhanced accessibility to mental health providers. Further work is required to determine if these interventions can improve health outcomes in patients with pediatric-onset chronic illnesses.

Identifying High-Need Primary Care Patients Using Nursing Knowledge and Machine Learning Methods.

Patient cohorts generated by machine learning can be enhanced with clinical knowledge to increase translational value and provide a practical approach to patient segmentation based on a mix of medical, behavioral, and social factors. This study aimed to generate a pragmatic example of how machine learning could be used to quickly and meaningfully cohort patients using unsupervised classification methods. Additionally, to demonstrate increased translational value of machine learning models through the integration of nursing knowledge. A primary care practice dataset (N = 3,438) of high-need patients defined by practice criteria was parsed to a subset population of patients with diabetes (n = 1233). Three expert nurses selected variables for k-means cluster analysis using knowledge of critical factors for care coordination. Nursing knowledge was again applied to describe the psychosocial phenotypes in four prominent clusters, aligned with social and medical care plans. Four distinct clusters interpreted and mapped to psychosocial need profiles, allowing for immediate translation to clinical practice through the creation of actionable social and medical care plans. (1) A large cluster of racially diverse female, non-English speakers with low medical complexity, and history of childhood illness; (2) a large cluster of English speakers with significant comorbidities (obesity and respiratory disease); (3) a small cluster of males with substance use disorder and significant comorbidities (mental health, liver and cardiovascular disease) who frequently visit the hospital; and (4) a moderate cluster of older, racially diverse patients with renal failure. This manuscript provides a practical method for analysis of primary care practice data using machine learning in tandem with expert clinical knowledge.

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

&lt;b&gt;Introduction:&lt;/b&gt; End-of-life medical care (ELMC) plans and do-not-resuscitate (DNR) decision-making are usually affected by multiple factors compared to other medical care decisions.&lt;b&gt; &lt;/b&gt;ELMC and DNR policy implementation are still diversified and heterogeneous, especially in Saudi Arabia, because policymakers have adopted no guidelines. Thus, this study investigated physicians’ knowledge, attitude, and practice regarding ELMC and DNR.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; A cross-sectional study design was adopted. Three hundred physicians working at King Fahad Hospital of the University, Khobar, Saudi Arabia, were randomly selected and administered an anonymous self-administered questionnaire using the Likert scale. Data analysis was carried out using SPSS 23.0.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Of 300 distributed questionnaires, 264 (88%) were completed and analysed. Knowledge gaps and negative attitudes were observed, a quarter of the participants were opposed to issuing a DNR order, and 29.0% considered DNR as equal to euthanasia as they practice. The participants’ patient age and religious factors were the most critical factors in the ELMC plan and DNR decision. The physician’s level of acceptance regarding a set of ELMC interventions and DNR decisions showed heterogenicity and uncertainty among participants.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The ELMC plan and DNR decision-making should be appropriately addressed in the medical residents’ training programs to bridge the knowledge gap and the physicians’ negative attitudes during their practice. Additionally, there is a need to update and unify the DNR policies at the national level, considering the patient’s right to be informed and involved actively during the decision process making. Finally, more prospective research is needed for the global standardization of ELMC.