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

Abstract

<b>Introduction:</b> 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.<b> </b>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.<br /> <b>Methods:</b> 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.<br /> <b>Results: </b>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.<br /> <b>Conclusions:</b> 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.

Do not attempt cardiopulmonary resuscitation decision-making process: scoping review

“…The findings from this review highlight that both timing and equality in the relationship between medical practitioners and their patients/those close to the patient are essential. 78 It is this relationship that enables an open conversation and dialogue to occur thereby facilitating the DNACPR decision-making process. 35 Medical practitioners are expected to share information, knowledge and clinical decisions with their patients to help patients and those close to the patient to come to an informed decision.…”

“…63 Of note was that 50% of physicians stated that it is unimportant to review the DNACPR order periodically and that there is no need to undo it for any reason. 64 There was a strong emphasis on the need for a clear DNACPR policy with 98%, 65 94%, 17 74% 60 of their samples reporting the need for policy and that there should be legislation regarding DNACPR. 65 It is recognised that there are substantive differences in the design of hospital code status options which may contribute to known variability in end-of-life care and treatment intensity among USA hospitals 66 and data supports the idea that…”

“…In addition to providing information to the patient, Alsaati et al, 20 Alwazzeh et al 64 and Ding et al 69 recommend that healthcare professionals also provide an explanation of DNACPR decisions to those close to the patient. This can help avoid misunderstandings, avoid stress on those close to the patient and create a better atmosphere for communication.…”