| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC.
Correspondence to: William Kelly, MD, Pulmonary and Critical Care Medicine, Walter Reed Army Medical Center, Washington, DC 20307; e-mail: WilliamKellyMD{at}AOL.com
Study objective: Opinions regarding do-not-resuscitate (DNR) decisions differ between individual physicians. We attempted to determine whether the strength of DNR recommendations varies with medical specialty and experience.
Design: Written survey.
Participants: Physicians from the pulmonary/critical-care medicine (PCCM), cardiology, internal medicine, gastroenterology, hematology/oncology, and infectious disease services as well as the Department of Medicine house staff at our tertiary-care referral center participated in the study.
Interventions: Physicians were asked confidentially to quantify the strength of their opinions on discussing and recommending DNR orders for each of 20 vignettes made from the summaries of actual cases. Reasons for their opinions and demographic data also were recorded.
Measurements and results: One hundred fifteen of 155 physicians (74%) responded. PCCM physicians (mean [± SD] DNR score, 157 ± 22) more strongly recommended DNR orders than cardiologists (mean DNR score, 122 ± 32; p = 0.006), house staff (mean DNR score, 132 ± 24; p = 0.014), and general internists (mean DNR score, 129 ± 30; p = 0.043). PCCM physicians also trended toward recommending DNR orders for more of the 20 patients described in the vignettes compared to cardiologists (mean DNR number, 16.5 ± 3.0 vs 11.9 ± 5.8, respectively; p = 0.066). There were no differences between PCCM physicians and hematology/oncology, infectious disease, and gastroenterology specialists. Among the house staff, the likelihood of recommending a DNR order correlated significantly with increasing years of experience (r = 0.45; p = 0.002). The opposite trend was present in the specialty staff groups. No significant differences in opinion by gender, religion, or personal experiences were found.
Conclusions: The strength of DNR order recommendations varies with medicine specialty and years of training and experience. An awareness of these differences and the determination of the reasons behind them may help to target educational interventions and to ensure effective collaboration with colleagues and communication with patients.
Key Words: advance directives • cardiopulmonary resuscitation • do-not-resuscitate • end-of-life • resuscitation • specialists • specialty • training
This article has been cited by other articles:
|
|
 |
|
  N. Chakraborty and W. J. Creaney 'Do not resuscitate' decisions in continuing care psychiatric patients: what influences decisions? Psychiatr. Bull., October 1, 2006; 30(10): 376 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Peabody, J. Luck, P. Glassman, S. Jain, J. Hansen, M. Spell, and M. Lee Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study Ann Intern Med, November 16, 2004; 141(10): 771 - 780. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B. Hardin and Y. A. Yusufaly Difficult End-of-Life Treatment Decisions: Do Other Factors Trump Advance Directives? Arch Intern Med, July 26, 2004; 164(14): 1531 - 1533. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Salomon, A. Tandon, and C. J L Murray Comparability of self rated health: cross sectional multi-country survey using anchoring vignettes BMJ, January 31, 2004; 328(7434): 258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Minerva BMJ, October 6, 2003; 327(7418): E127 - 127. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Arnett Jr, W. F. Kelly, A. H. Eliasson, and O. W. Hnatiuk End-of-Life Care: Data Supportive? Chest, November 1, 2002; 122(5): 1867 - 1868. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
