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Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making

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@article{a0cd0e5ba2954380b6ad3b07e81ff03c,
title = "Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making",
abstract = "PURPOSE: Do-not-resuscitate (DNR) decision-making in severely ill patients presents many difficult medical, ethical, and legal challenges. The primary aim of this study was to explore cancer patients' and health care professionals' attitudes regarding DNR decision-making authority and timing of the decision.METHODS: This study was a questionnaire survey among Danish cancer patients and their attending physicians and nurses in an oncology outpatient setting. Potential differences between patients', physicians', and nurses' answers to the questionnaire were analyzed using Fisher's exact test.RESULTS: Responses from 904 patients, 59 physicians, and 160 nurses were analyzed. The majority in all three groups agreed that DNR decisions should be made in collaboration between physician and patient. However, one-third of the patients answered that the patient alone should make the decision regarding DNR, which contrasts with the physicians' and nurses' attitudes, 0% and 6% pointing to the patient as sole decision-maker, respectively. In case of disagreement between patient and physician, a majority of both patients (66%) and physicians (86%) suggested themselves as the ultimate decision-maker. Additionally, 43% of patients but only 19% of physicians preferred the DNR discussion being brought up early in the course of the disease.CONCLUSIONS: With regard to the decisional role of patient vs. physician and the timing of the DNR discussion, we found a substantial discrepancy between the attitudes of cancer patients and physicians. This discrepancy calls for a greater awareness and discussion of this sensitive topic among both health care professionals and the public.",
keywords = "Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Attitude to Death, Decision Making, Denmark/epidemiology, Female, Humans, Male, Medical Oncology, Medical Staff, Hospital/psychology, Middle Aged, Neoplasms/diagnosis, Nurses/psychology, Patients/psychology, Physicians/psychology, Professional-Patient Relations, Resuscitation Orders/psychology, Surveys and Questionnaires, Time Factors, Do-not-resuscitate, Decisional role, Resuscitation order, Decision, Timing, Cancer",
author = "Lena Saltb{\ae}k and Michelsen, {Hanne M} and Nelausen, {Knud M} and Susann Theile and Christian Dehlendorff and Dalton, {Susanne O} and Nielsen, {Dorte L}",
year = "2020",
month = dec,
doi = "10.1007/s00520-020-05460-7",
language = "English",
volume = "28",
pages = "6057--6066",
journal = "Supportive Care in Cancer",
issn = "0941-4355",
publisher = "Springer",
number = "12",

}

RIS

TY - JOUR

T1 - Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making

AU - Saltbæk, Lena

AU - Michelsen, Hanne M

AU - Nelausen, Knud M

AU - Theile, Susann

AU - Dehlendorff, Christian

AU - Dalton, Susanne O

AU - Nielsen, Dorte L

PY - 2020/12

Y1 - 2020/12

N2 - PURPOSE: Do-not-resuscitate (DNR) decision-making in severely ill patients presents many difficult medical, ethical, and legal challenges. The primary aim of this study was to explore cancer patients' and health care professionals' attitudes regarding DNR decision-making authority and timing of the decision.METHODS: This study was a questionnaire survey among Danish cancer patients and their attending physicians and nurses in an oncology outpatient setting. Potential differences between patients', physicians', and nurses' answers to the questionnaire were analyzed using Fisher's exact test.RESULTS: Responses from 904 patients, 59 physicians, and 160 nurses were analyzed. The majority in all three groups agreed that DNR decisions should be made in collaboration between physician and patient. However, one-third of the patients answered that the patient alone should make the decision regarding DNR, which contrasts with the physicians' and nurses' attitudes, 0% and 6% pointing to the patient as sole decision-maker, respectively. In case of disagreement between patient and physician, a majority of both patients (66%) and physicians (86%) suggested themselves as the ultimate decision-maker. Additionally, 43% of patients but only 19% of physicians preferred the DNR discussion being brought up early in the course of the disease.CONCLUSIONS: With regard to the decisional role of patient vs. physician and the timing of the DNR discussion, we found a substantial discrepancy between the attitudes of cancer patients and physicians. This discrepancy calls for a greater awareness and discussion of this sensitive topic among both health care professionals and the public.

AB - PURPOSE: Do-not-resuscitate (DNR) decision-making in severely ill patients presents many difficult medical, ethical, and legal challenges. The primary aim of this study was to explore cancer patients' and health care professionals' attitudes regarding DNR decision-making authority and timing of the decision.METHODS: This study was a questionnaire survey among Danish cancer patients and their attending physicians and nurses in an oncology outpatient setting. Potential differences between patients', physicians', and nurses' answers to the questionnaire were analyzed using Fisher's exact test.RESULTS: Responses from 904 patients, 59 physicians, and 160 nurses were analyzed. The majority in all three groups agreed that DNR decisions should be made in collaboration between physician and patient. However, one-third of the patients answered that the patient alone should make the decision regarding DNR, which contrasts with the physicians' and nurses' attitudes, 0% and 6% pointing to the patient as sole decision-maker, respectively. In case of disagreement between patient and physician, a majority of both patients (66%) and physicians (86%) suggested themselves as the ultimate decision-maker. Additionally, 43% of patients but only 19% of physicians preferred the DNR discussion being brought up early in the course of the disease.CONCLUSIONS: With regard to the decisional role of patient vs. physician and the timing of the DNR discussion, we found a substantial discrepancy between the attitudes of cancer patients and physicians. This discrepancy calls for a greater awareness and discussion of this sensitive topic among both health care professionals and the public.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Attitude of Health Personnel

KW - Attitude to Death

KW - Decision Making

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Male

KW - Medical Oncology

KW - Medical Staff, Hospital/psychology

KW - Middle Aged

KW - Neoplasms/diagnosis

KW - Nurses/psychology

KW - Patients/psychology

KW - Physicians/psychology

KW - Professional-Patient Relations

KW - Resuscitation Orders/psychology

KW - Surveys and Questionnaires

KW - Time Factors

KW - Do-not-resuscitate

KW - Decisional role

KW - Resuscitation order

KW - Decision

KW - Timing

KW - Cancer

UR - http://www.scopus.com/inward/record.url?scp=85083790925&partnerID=8YFLogxK

U2 - 10.1007/s00520-020-05460-7

DO - 10.1007/s00520-020-05460-7

M3 - Journal article

C2 - 32291599

VL - 28

SP - 6057

EP - 6066

JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

SN - 0941-4355

IS - 12

ER -

ID: 61925679