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

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Abstract

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.

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Authors and Affiliations

  1. Department of Oncology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 7, DK-2730, Herlev, Denmark

    Lena Saltbæk, Hanne M. Michelsen, Knud M. Nelausen, Susann Theile & Dorte L. Nielsen

  2. Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark

    Lena Saltbæk & Susanne O. Dalton

  3. Department of Oncology, Zealand University Hospital, Ringstedgade 61, DK-4700, Næstved, Denmark

    Lena Saltbæk & Susanne O. Dalton

  4. Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark

    Christian Dehlendorff

Authors
  1. Lena Saltbæk
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  2. Hanne M. Michelsen
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  3. Knud M. Nelausen
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  4. Susann Theile
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  5. Christian Dehlendorff
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  6. Susanne O. Dalton
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  7. Dorte L. Nielsen
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Corresponding author

Correspondence to Lena Saltbæk.

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The authors declare no potential conflicts of interest.

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The study was not funded.

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Knud M. Nelausen died before the study was published.

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Saltbæk, L., Michelsen, H.M., Nelausen, K.M. et al. Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making. Support Care Cancer 28, 6057–6066 (2020). https://doi.org/10.1007/s00520-020-05460-7

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