Citation Information :
Gouda A, Alrasheed N, Ali A, Allaf A, Almudaiheem N, Ali Y, Alghabban A, Alsalolami S. Knowledge and attitude of ER and intensive care unit physicians toward Do-Not-Resuscitate in a Tertiary Care Center in Saudi Arabia: A survey study. Indian J Crit Care Med 2018; 22 (4):214-222.
Introduction: Only a few studies from Arab Muslim countries address do-not-resuscitate (DNR) practice. The knowledge of physicians about the existing policy and the attitude towards DNR were surveyed.
Objective: The objective of this study is to identify the knowledge of the participants of the local DNR policy and barriers of addressing DNR including religious background.
Methods: A questionnaire has been distributed to Emergency Room (ER) and Intensive Care Unit (ICU) physicians.
Results: A total of 112 physicians mostly Muslims (97.3%). About 108 (96.4%) were aware about the existence of DNR policy in our institute. 107 (95.5%) stated that DNR is not against Islamic. Only (13.4%) of the physicians have advance directives and (90.2%) answered they will request to be DNR if they have terminal illness. Lack of patients and families understanding (51.8%) and inadequate training (35.7%) were the two most important barriers for effective DNR discussion. Patients and families level of education (58.0%) and cultural factors (52.7%) were the main obstacles in initiating a DNR order.
Conclusions: There is a lack of knowledge about DNR policy which makes the optimization of DNR process difficult. Most physicians wish DNR for themselves and their patients at the end of life, but only a few of them have advance directives. The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the culture of patients. Most of the Muslim physicians believe that DNR is not against Islamic rules. We suggest that the DNR concept should be a part of any training program.
McClung JA, Kamer RS. Implications of New York's do-not-resuscitate law. N Engl J Med 1990;323:270-2.
Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med 1983;309:569-76.
Stolman CJ, Gregory JJ, Dunn D, Levine JL. Evaluation of patient, physician, nurse, and family attitudes toward do not resuscitate orders. Arch Intern Med 1990;150:653-8.
Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European Intensive Care Units: The Ethicus study. JAMA 2003;290:790-7.
Vincent JL. Forgoing life support in Western European Intensive Care Units: The results of an ethical questionnaire. Crit Care Med 1999;27:1626-33.
Sprung CL, Maia P, Bulow HH, Ricou B, Armaganidis A, Baras M, et al. The importance of religious affiliation and culture on end-of-life decisions in European Intensive Care Units. Intensive Care Med 2007;33:1732-9.
Babgi A. Legal issues in end-of-life care: Perspectives from Saudi Arabia and United States. Am J Hosp Palliat Care 2009;26:119-27.
Takrouri M, Halwani T. An Islamic medical and legal prospective of do not resuscitate order in critical care medicine. Internet J Health 2007;1:1-7.
Mobeireek A. The do-not resuscitate order: Indications on the current practice in Riyadh. Ann Saudi Med 1995;15:6-9.
Albugami M, Bassil H, Laudon U, Ibrahim A, Elamin A, ElAlem U, et al. Medical residents' practices and perceptions toward do-not- resuscitate (DNR) order. J Palliat Care Med 2017;7:295-302.
Aljohaney A, Bawazir Y. Internal medicine residents' perspectives and practice about do not resuscitate orders: Survey analysis in the western region of Saudi Arabia. Adv Med Educ Pract 2015;6:393-8.
Amoudi AS, Albar MH, Bokhari AM, Yahya SH, Merdad AA. Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia. Adv Med Educ Pract 2016;7:165-70.
Granja C, Teixeira-Pinto A, Costa-Pereira A. Attitudes towards do-not-resuscitate decisions: Differences among health professionals in a Portuguese hospital. Intensive Care Med 2001;27:555-8.
Gouda A, Al-Jabbary A. Lian Fong intensive care medicine. Intensive Care Med 2010;36:2149-53.
Al-Mobeireek AF. Physicians' attitudes towards 'do-not-resuscitate' orders for the elderly: A survey in Saudi Arabia. Arch Gerontol Geriatr 2000;30:151-60.
Tayeb MA, Al-Zamel E, Fareed MM, Abouellail HA. A “good death”: Perspectives of Muslim patients and health care providers. Ann Saudi Med 2010;30:215-21.
Periyakoil VS, Neri E, Fong A, Kraemer H. Do unto others: Doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives. PLoS One 2014;9:e98246.
Beach MC, Morrison RS. The effect of do-not-resuscitate orders on physician decision-making. J Am Geriatr Soc 2002;50:2057-61.
Saeed F, Kousar N, Aleem S, Khawaja O, Javaid A, Siddiqui MF, et al. End-of-life care beliefs among Muslim physicians. Am J Hosp Palliat Care 2015;32:388-92.
Al Sheef MA, Al Sharqi MS, Al Sharief LH, Takrouni TY, Mian AM. Awareness of do-not-resuscitate orders in the outpatient setting in Saudi Arabia. Perception and implications. Saudi Med J 2017;38:297-301.
Bülow HH, Sprung CL, Reinhart K, Prayag S, Du B, Armaganidis A, et al. The world's major religions' points of view on end-of-life decisions in the Intensive Care Unit. Intensive Care Med 2008;34:423-30.
Bülow HH, Sprung CL, Baras M, Carmel S, Svantesson M, Benbenishty J, et al. Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study. Intensive Care Med 2012;38:1126-33.
Schenker Y, Tiver GA, Hong SY, White DB. Association between physicians' beliefs and the option of comfort care for critically ill patients. Intensive Care Med 2012;38:1607-15.
Rahman MU, Arabi Y, Adhami NA, Parker B, Al-Shimemeri A. The practice of do-not-resuscitate orders in the kingdom of Saudi Arabia. The experience of a tertiary care center. Saudi Med J 2004;25:1278-9.
Aldawood AS, Alsultan M, Arabi YM, Baharoon SA, Al-Qahtani S, Haddad SH, et al. End-of-life practices in a tertiary Intensive Care Unit in Saudi Arabia. Anaesth Intensive Care 2012;40:137-41.
A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT principal investigators. JAMA 1995;274:1591-8.
Sprung CL, Carmel S, Sjokvist P, Baras M, Cohen SL, Maia P, et al. Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: The ETHICATT study. Intensive Care Med 2007;33:104-10.