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

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.

Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt.

BACKGROUND: The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated. PURPOSE: The purpose of this study was to determine the impact of different patient characteristics on the following outcomes: (1) patients' wishes for or against CPR, (2) assessments made by physicians of the indication for CPR, and (3) the probability of discordance between patients' wishes and physicians' assessments. METHODS: In this survey, 1,128 of 1,408 cancer patients received a questionnaire concerning their wish for CPR. In total, 904 patients responded. A total of 61 treating physicians assessed the medical indication for resuscitation. Different predefined patient characteristics were analyzed using both univariate and multivariate analyses. RESULTS: Ninety percent of responding patients wished to receive CPR. The physicians found indications supporting CPR in 89 % of patients. Age ≥70 years, increasing line of treatment, poor prognosis, living alone, and poor self-rated physical and mental health enhanced both patients' wishes and physicians' assessments to withhold CPR. However, only age ≥70 years, poor prognosis, and poor self-rated physical health significantly predicted rejection of CPR in multivariate analyses. The likelihood of discordance between patients and physicians was significantly higher when the patient was ≥70 years and when the expected 5-year survival was <25 %. CONCLUSIONS: Factors associated with the imminence of dying influenced both patients and physicians to refrain from CPR, and perhaps more surprisingly, the probability of discordance between patients and physicians increased.