TY - JOUR
T1 - Do specialists differ on do-not-resuscitate decisions?
AU - Kelly, William F.
AU - Eliasson, Arn H.
AU - Stocker, Derek J.
AU - Hnatiuk, Oleh W.
PY - 2002
Y1 - 2002
N2 - Study objective: Opinions regarding do-not-resuscitate (DNR) decisions differ between individual physicians. We attempted to determine whether the strength of DNR recommendations varies with medical specialty and experience. Design: Written survey. Participants: Physicians from the pulmonary/critical-care medicine (PCCM), cardiology, internal medicine, gastroenterology, hematology/oncology, and infectious disease services as well as the Department of Medicine house staff at our tertiary-care referral center participated in the study. Interventions: Physicians were asked confidentially to quantify the strength of their opinions on discussing and recommending DNR orders for each of 20 vignettes made from the summaries of actual cases. Reasons for their opinions and demographic data also were recorded. Measurements and results: One hundred fifteen of 155 physicians (74%) responded. PCCM physicians (mean [± SD] DNR score, 157 ± 22) more strongly recommended DNR orders than cardiologists (mean DNR score, 122 ± 32; p = 0.006), house staff (mean DNR score, 132 ± 24; p = 0.014), and general internists (mean DNR score, 129 ± 30; p = 0.043). PCCM physicians also trended toward recommending DNR orders for more of the 20 patients described in the vignettes compared to cardiologists (mean DNR number, 16.5 ± 3.0 vs 11.9 ± 5.8, respectively; p = 0.066). There were no differences between PCCM physicians and hematology/oncology, infectious disease, and gastroenterology specialists. Among the house staff, the likelihood of recommending a DNR order correlated significantly with increasing years of experience (r = 0.45; p = 0.002). The opposite trend was present in the specialty staff groups. No significant differences in opinion by gender, religion, or personal experiences were found. Conclusions: The strength of DNR order recommendations varies with medicine specialty and years of training and experience. An awareness of these differences and the determination of the reasons behind them may help to target educational interventions and to ensure effective collaboration with colleagues and communication with patients.
AB - Study objective: Opinions regarding do-not-resuscitate (DNR) decisions differ between individual physicians. We attempted to determine whether the strength of DNR recommendations varies with medical specialty and experience. Design: Written survey. Participants: Physicians from the pulmonary/critical-care medicine (PCCM), cardiology, internal medicine, gastroenterology, hematology/oncology, and infectious disease services as well as the Department of Medicine house staff at our tertiary-care referral center participated in the study. Interventions: Physicians were asked confidentially to quantify the strength of their opinions on discussing and recommending DNR orders for each of 20 vignettes made from the summaries of actual cases. Reasons for their opinions and demographic data also were recorded. Measurements and results: One hundred fifteen of 155 physicians (74%) responded. PCCM physicians (mean [± SD] DNR score, 157 ± 22) more strongly recommended DNR orders than cardiologists (mean DNR score, 122 ± 32; p = 0.006), house staff (mean DNR score, 132 ± 24; p = 0.014), and general internists (mean DNR score, 129 ± 30; p = 0.043). PCCM physicians also trended toward recommending DNR orders for more of the 20 patients described in the vignettes compared to cardiologists (mean DNR number, 16.5 ± 3.0 vs 11.9 ± 5.8, respectively; p = 0.066). There were no differences between PCCM physicians and hematology/oncology, infectious disease, and gastroenterology specialists. Among the house staff, the likelihood of recommending a DNR order correlated significantly with increasing years of experience (r = 0.45; p = 0.002). The opposite trend was present in the specialty staff groups. No significant differences in opinion by gender, religion, or personal experiences were found. Conclusions: The strength of DNR order recommendations varies with medicine specialty and years of training and experience. An awareness of these differences and the determination of the reasons behind them may help to target educational interventions and to ensure effective collaboration with colleagues and communication with patients.
KW - Advance directives
KW - Cardiopulmonary resuscitation
KW - Do-not-resuscitate
KW - End-of-life
KW - Resuscitation
KW - Specialists
KW - Specialty
KW - Training
UR - http://www.scopus.com/inward/record.url?scp=0036202402&partnerID=8YFLogxK
U2 - 10.1378/chest.121.3.957
DO - 10.1378/chest.121.3.957
M3 - Article
C2 - 11888982
AN - SCOPUS:0036202402
SN - 0012-3692
VL - 121
SP - 957
EP - 963
JO - Chest
JF - Chest
IS - 3 SUPPL.
ER -