[Resuscitation decision in cases of hospital cardiac arrest--current practices and opinions of physicians].

Abstract

Unlabelled: BACKGROUND; DNAR is the procedure when CPR is not undertaken as it appears to conflict with the patient's will or may not be in his or her best interests due to medical futility. DNAR decisions should be carefully discussed in advance by the medical team and patients and finally formally documented. DNAR orders are still extremely rare in Polish hospitals and decisions to forgo CPR are usually made at the very last moment. Therefore, we compare actual practice and opinions of physicians related to DNAR decisions.

Methods: The study, carried out during three consecutive months in a big university hospital, was based on two questionnaires. The first questionnaire explored actual practice regarding the decision to forgo CPR, whereas the second one--opinions about DNAR guidelines. The former was filled in by physicians involved in the "do not to attempt resuscitation" decision, the latter by the group of other physicians employed in the hospital.

Results: The survey was performed among 286 physicians filling in the first questionnaire and 200 physicians completing the second one. On-call doctors were prime decision makers (49%) with no input from the patient when the "do not attempt resuscitation" decision was made. Decisions to forgo resuscitation were usually informal and communicated to medical team orally (98%). However, 20% of physicians declare that patients should be involved in the decision-making process concerning CPR, and more then 30% respondents stress the need for collegial discussion. Nearly 80% of physicians believe that such formal decisions should be recorded in the patient's medical history.

Conclusions: Current opinions of physicians regarding DNAR differ strikingly from clinical practice. Respondents highlighted the need for collegial discussions, the growing role of a patient in the decision-making process and importance of suitable documentation.