PURPOSE: Opinions regarding do-not-resuscitate (DNR) decisions have the potential to differ greatly between individual physicians. In 2000, our research group conducted a survey to assess differences in DNR decision-making at our hospital. Ten years later, we repeated the survey for comparison.
METHODS: Physicians were invited to confidentially participate in a survey questionnaire of clinical vignettes (identical to the prior survey). Demographic data included age, gender, clinical specialty, and years of practice. Answers to the twenty questions were summed for a composite DNR score (possible score range, 20 to 200). Comparisons between groups were made using two-sample t test. The association of DNR score and years since medical school graduation was examined using the Pearson correlation coefficient.
RESULTS: Of the 288 questionnaires distributed, 60 (21%) were returned. Attending physicians comprised the majority (60%), followed by fellows (23%), and house staff (17%). The mean total scaled responses assessed strength of opinions out of a possible score of 200 (range 45-184). The mean DNR score for the total cohort was 121±41. Scores were not significantly different between groups (housestaff, 129±23; fellows, 122±25; attendings, 117±34; p=0.27). Likewise, mean DNR scores were similar regardless of years of practice (rs=0.18, p=0.21). The mean DNR score for current cohort (128±30, n=24) was similar to the prior cohort (129±30, n=14; p=0.92).
CONCLUSIONS: The strength of DNR recommendations did not vary by training level or years of experience, nor did the overall mean score differ significantly from the original study. However, within the original study, there was a statistically significant trend indicating a decreasing endorsement of DNR orders with greater distance from residency training. It was posited that this trend was due to greater educational emphasis on end-of-life issues at the time. The absence of a similar trend in our study may reinforce this hypothesis.
CLINICAL IMPLICATIONS: The decision to recommend DNR status for a patient has become more uniform in the past decade, possibly due to increased education and exposure during medical training.
DISCLOSURE: The following authors have nothing to disclose: Robert Walter, Jacob Collen, William Kelly
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