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Taha M, Aldabali FOM, Alotaibi SH, Melybari RZ, Alqelaiti BA, Alderhami AM, Bajaber TA. Knowledge and Attitude of the General Population About Do Not Resuscitate (DNR) in the Western Region, Saudi Arabia. Cureus 2023; 15:e44143. [PMID: 37753038 PMCID: PMC10518639 DOI: 10.7759/cureus.44143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A do-not-resuscitate (DNR) order is a medical order issued by a doctor. It directs medical professionals to refrain from performing cardiopulmonary resuscitation (CPR) if a patient's breathing or heartbeat ceases. Patients can refuse CPR in an emergency if they have a DNR order. The DNR order includes precise directives about CPR. Instructions for extra therapies like nourishment, other drugs, or painkillers are not included. AIM The aim of the study is to learn more about the western region's general population's knowledge and attitudes toward DNR orders and identify any challenges that may arise when dealing with DNR patients. METHODOLOGY A cross-sectional study was conducted in 2023 in the western region of Saudi Arabia. An online, self-administered questionnaire was distributed randomly from April 8, 2023 to June 6, 2023. The estimated sample size was 384, and 604 were the collected responses. RESULTS A total of 383 (63.4%) participants were females, and 221 (36.6%) were males. Regarding the knowledge and attitude of the general population about DNR orders in the western region of Saudi Arabia, 276 (45.7%) study participants had satisfactory knowledge and awareness, while 328 (54.3%) had inadequate knowledge. A total of 343 (56.8%) participants thought that DNR is important; 255 (42.2%) felt that the DNR has reduced the pain of their relatives, and 181 (30%) believed that it has reduced the stress felt by the patient's families. Of participants aged 20-30 years, 58.4% had satisfactory knowledge about DNR orders compared with those aged 50 and above; 76.1% of healthcare workers had satisfactory knowledge versus 26.5% of unemployed participants (P=.001). CONCLUSION We recommend increasing awareness and knowledge about DNR by conducting educational events about the concept and how to deal with patients who choose to acquire a DNR order.
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Affiliation(s)
- Medhat Taha
- Department of Anatomy, Al-Qunfudah Medical College, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | - Solaf Hilal Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Qutob RA, Aljarba NK, Alhusaini BA, Alzaid ON, Alghamdi AH, Alaryni AA, Bukhari AI, Alburakan A, Alanazi AM, Alsolamy EN, Alfozan OA, Alzmamy SA, Ababtain AA, Elhazmi A, Hakami OA. The Perspective of the General Population in Saudi Arabia towards Do-Not-Resuscitate (DNR) Orders: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2073. [PMID: 37510514 PMCID: PMC10378939 DOI: 10.3390/healthcare11142073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is an emergency procedure used to maintain the heart and lungs functional simultaneously. The do-not-resuscitate (DNR) order prohibits CPR and is therefore legally required. Despite this, a DNR remains a delicate and contentious issue that places physicians in morally ambiguous situations. This study aimed to assess Saudi citizens' understanding of DNR orders, prior exposure to them, and preferences for DNR conversations. METHODS This was an online cross-sectional study that was conducted between January and April 2023 and aimed to assess the knowledge regarding DNR orders among Saudi populations. This study adapted a previously developed questionnaire tool by Al Ahmadi et al., which examined the knowledge and attitude toward do-not-resuscitate among patients and their relatives visiting outpatient clinics. Binary logistic regression analysis was the mean knowledge score for the study participants. RESULTS A total of 920 participants were involved in this study. Almost half of the study participants (49.6%) reported that they had heard of DNR before. The most commonly reported source of their information on DNR was healthcare providers (58.2%). The mean knowledge score of the study participants was 1.9 (1.3) out of 6, which is equal to 31.7% of the total maximum score. This demonstrates the weak level of knowledge about DNR among the general public. Females, divorced, and those who had a post-graduate level of education were more likely to be knowledgeable of DNR compared to others (p < 0.05). Around one-quarter of the study participants showed agreement with DNR. More than half of them (59.5%) believe that physicians should be involved in DNR decision making. CONCLUSIONS Saudi Arabia's general community has limited knowledge of DNR. It is recommended that healthcare professionals increase patients' and caregivers' understanding of this concept. This will improve the planning and the provision of end-of-life care.
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Affiliation(s)
- Rayan Abubakker Qutob
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Najd Khalid Aljarba
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | | | - Omar Nasser Alzaid
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | | | | | | | - Ahmed Alburakan
- Department of Surgery, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | | | - Eysa Nahar Alsolamy
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Omar Abdulaziz Alfozan
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Saad Abdullah Alzmamy
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Abdalmohsen A Ababtain
- Critical Care Department, King Abdullah bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh 11451, Saudi Arabia
| | - Alyaa Elhazmi
- College of Medicine, AlFaisal University, Riyadh 11533, Saudi Arabia
| | - Osamah A Hakami
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
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Alahmadi S, Al Shahrani M, Albehair M, Alghamdi A, Alwayel F, Turkistani A, Alahmadi A, Shehab Z. Do-not-resuscitate (DNR) Orders' Awareness and Perception Among Physicians: a National Survey. Med Arch 2023; 77:288-292. [PMID: 37876561 PMCID: PMC10591250 DOI: 10.5455/medarh.2023.77.288-292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/28/2023] [Indexed: 10/26/2023] Open
Abstract
Background The concept of do-not-resuscitate (DNR) orders began when medical and surgical interventions increased the possibility of resuscitation in dying patients. Healthcare providers should start to care more about the quality of life rather than quantity. The acceptance of signing DNR orders varies among physicians owing to different reasons and conceptions. Objective The aim of this national survey was to evaluate the extent of physicians' knowledge and attitude towards do-not-resuscitate (DNR) orders in different hospitals and specialties in Saudi Arabia. Methods A cross-sectional study was conducted in Saudi Arabia and other Arab Gulf countries between March 2019 and May 2021. Results A total of 409 physicians completed the questionnaire (53.3% male, 47% of the participants were less than 30 years of age). Most participants had their residency medical training in Saudi Arabia (73.6%, n=281); 33.5% were emergency medicine (EM) physicians. Among 409 patients, 92.7% (n=379 ) were familiar with the DNR (do-not-resuscitate) ter. Half of the participants had never discussed a DNR status with the patient or family (n=215, 52.6%), however, only 38.4% had read the policy. A total of 275 (67.2%) participants were aware that their institute had a DNR policy, and a lack of patient/family understanding was the most common barrier for the majority to initiate DNR orders (53.9%, n=222). Most of the participants (65.8%, n=269) acknowledged a lack of training and understanding of the concepts of DNR orders. Conclusion Most physicians who participated in this study were aware of the DNR order concept; however, half of them had never discussed or signed a DNR order. Patients and their families' misunderstandings were considered the main barriers. In addition, the lack of training in the concepts of DNR orders was considered a major obstacle.
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Affiliation(s)
- Sarah Alahmadi
- Department of Emergency Medicine, King Fahad Hospital of the University. Khobar, Saudi Arabia
| | - Mohammed Al Shahrani
- Department of Emergency Medicine, King Fahad Hospital of the University. Khobar, Saudi Arabia
| | - Maan Albehair
- Department of Pediatric Emergency, Maternity and Children Hospital, Khobar, Saudi Arabia
| | - Abdulrahman Alghamdi
- Department of Emergency Medicine, King Fahad Hospital of the University. Khobar, Saudi Arabia
| | - Faten Alwayel
- Department of Emergency Medicine, King Fahad Hospital of the University. Khobar, Saudi Arabia
| | - Alaa Turkistani
- Department of Emergency Medicine, King Fahad Hospital of the University. Khobar, Saudi Arabia
| | | | - Zainab Shehab
- King Fahad Military Medical Complex, Dhahran,Saudi Arabia
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Woodman A, Waheed KB, Rasheed M, Ahmad S. Current state of ethical challenges reported in Saudi Arabia: a systematic review & bibliometric analysis from 2010 to 2021. BMC Med Ethics 2022; 23:82. [PMID: 35964019 PMCID: PMC9375198 DOI: 10.1186/s12910-022-00816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Over the past few years, five domains of importance about the current state of bioethics in Saudi Arabia have shaped the perspective of most research: doctor-patient relationship, informed consent, do-not-resuscitate, organ donation, and transplantation, medical students’ knowledge and attitudes about medical ethics curriculum. This systematic review aimed to systematically identify, compile, describe and discuss ethical arguments and concepts in the best-studied domains of bioethics in Saudi Arabia and to present cultural, social, educational, and humane perspectives.
Methods Six databases were searched using Boolean operators (PubMed, Embase, Web of Science, Scopus, CINAHL, Google Scholar) from December 2020–June 2021. The search and report process followed the statement and flowchart of preferred reporting items for systematic reviews and meta-analyses (PRISMA). Resutls The search resulted in 1651 articles, of which 82 studies were selected for a final review and assessment. There is a gradual increase in research, whereby a substantial increase was observed from 2017. Most of the published articles focused on ‘Organ Donation & Transplantation’ with 33 articles, followed by ‘Doctor-Patient Relations’ with 18 publications. Most of the published articles were from Central Province (33), followed by Western Province (16). The authorship pattern showed a collaborative approach among researchers. The thematic analysis of keywords analysis showed that ‘Saudi Arabia,’ ‘attitude PHC,’ ‘organ donation,’ ‘knowledge and education,’ and ‘donation’ have been used the most commonly. Conclusion This systematic quantitative synthesis is expected to guide researchers, stakeholders, and policymakers about the strengths and gaps in knowledge and attitudes regarding medical ethics in Saudi Arabia, both among the general public and health professionals.
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Affiliation(s)
- Alexander Woodman
- Yale Interdisciplinary Center for Bioethics, Yale University, New Haven, CT, USA.
| | - Khawaja Bilal Waheed
- Radiodiagnostic and Imaging Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mohammad Rasheed
- Vice Deanship of Postgraduate Studies and Research, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Shakil Ahmad
- Deanship of Library Affairs, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Alkhalifah AS, AlSoqati A, Zahraa J. Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric Intensive Unit in Saudi Arabia. Front Pediatr 2022; 10:926686. [PMID: 35874581 PMCID: PMC9300935 DOI: 10.3389/fped.2022.926686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess the performance of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Index of Mortality III (PIM III) indices in a tertiary pediatric intensive care unit (PICU) in Saudi Arabia and to identify the factors affecting the observed performance. DESIGN Retrospective, single-center study using data collected from the Virtual Pediatric Systems web-based database. SETTING King Fahad Medical City PICU, Saudi Arabia. PATIENTS All pediatric patients <14 years of age admitted between 1 January 2015, and 31 December 2019. INTERVENTIONS Comparison of PRISM III and PIM III performances in predicting mortality across different age groups, disease categories, and resuscitation decision statuses. MEASUREMENTS Normality of distribution was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Patient characteristics were compared between survivors and non-survivors. The medians and ranges were calculated for continuous data, whereas frequencies and percentages were used for nominal data. The Mann-Whitney U test, Kruskal-Wallis test, and Chi-square test were used to compare the characteristics of survivors and non-survivors. MAIN RESULTS There was a significant difference between the predicted mortality and observed mortality in both the PRISM III and PIM III. Better discrimination was found after excluding do-not-resuscitate (DNR) patients. The worst calibration and discrimination were recorded for infants <12 months of age. The PRISM III performed significantly better in patients with metabolic/genetic and central nervous system illnesses. Non-DNR patients had a lower standardized mortality rate using the PRISM III and PIM III. The PRISM III and PIM III indices performed better in patients who died within the first week of admission. CONCLUSION These models had sufficient discrimination ability and poor calibration. Since they were designed for particular patient characteristics and PICUs, further testing in different environments is necessary before utilization for planning and assessing performance. Alternatively, new models could be developed which are suitable for local PICUs.
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Alshaikh R, AlKhalifah A, Fayed A, AlYousef S. Factors influencing the length of stay among patients admitted to a tertiary pediatric intensive care unit in Saudi Arabia. Front Pediatr 2022; 10:1093160. [PMID: 36601032 PMCID: PMC9806252 DOI: 10.3389/fped.2022.1093160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to assess the variables contributing to the length of stay in the pediatric intensive care unit. This study utilized a retrospective design by analyzing data from the Virtual Pediatric Systems web-based database. The study was conducted in a tertiary hospital-King Fahad Medical City in Riyadh, Saudi Arabia-from January 1, 2014 to December 31, 2019. The patients were admitted to intensive care with complex medical and surgical diseases. The variables were divided into quantitative and qualitative parameters, including patient data, Pediatric Risk of Mortality III score, and complications. Data from 3,396 admissions were analyzed. In this cohort, the median and mean length of stay were 2.8 (interquartile range, 1.08-7.04) and 7.43 (standard deviation, 14.34) days, respectively. The majority of long-stay patients-defined as those staying longer than 30 days-were less than 12 months of age (44.79%), had lower growth parameters (p < 0.001), and had a history of admission to pediatric intensive care units. Moreover, the majority of long-stay patients primarily suffered from respiratory diseases (51.53%) and had comorbidities and complications during their stay (p < 0.001). Multivariate analysis of all variables revealed that central line-associated bloodstream infections (p < 0.001), external ventricular drain insertion (p < 0.005), tracheostomy (p < 0.001), and use of mechanical ventilation (p < 0.001) had the most significant associations with a longer stay in the pediatric intensive care unit. The factors associated with longer stays included the admission source, central nervous system disease comorbidity, and procedures performed during the stay. Factors such as respiratory support were also associated with prolonged intensive care unit stays.
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Affiliation(s)
- Reem Alshaikh
- General Pediatric Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ahmed AlKhalifah
- Pediatric Intensive Care Unit, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Amel Fayed
- Clinical Sciences Department, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sawsan AlYousef
- Pediatric Intensive Care Unit, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Lin HM, Liu CK, Huang YC, Ho CW, Chen M. Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010428. [PMID: 35010693 PMCID: PMC8744657 DOI: 10.3390/ijerph19010428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/21/2022]
Abstract
Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.
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Affiliation(s)
- Hui-Mei Lin
- Taipei City Hospital, RenAi Branch Nursing Supervisor, Taipei 106, Taiwan;
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
| | - Chih-Kuang Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Yen-Chun Huang
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Chieh-Wen Ho
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Life Science, National Taiwan University, Taipei 106, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Correspondence:
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Dabar G, Akl IB, Sader M. Physicians' approach to end of life care: comparison of two tertiary care university hospitals in Lebanon. BMC MEDICAL EDUCATION 2021; 21:592. [PMID: 34823513 PMCID: PMC8620620 DOI: 10.1186/s12909-021-03022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. METHODS Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. RESULTS The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. CONCLUSION Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.
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Affiliation(s)
- George Dabar
- Pulmonary and Critical Care Division, Hotel Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache Achrafieh, PO Box 166830, Beirut, Lebanon
| | - Imad Bou Akl
- Pulmonary and Critical Care Division, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mirella Sader
- Anesthesia and Critical Care Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Aljethaily A, Al-Mutairi T, Al-Harbi K, Al-Khonezan S, Aljethaily A, Al-Homaidhi HS. Pediatricians' Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:1-8. [PMID: 32021536 PMCID: PMC6954090 DOI: 10.2147/amep.s228399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore the pediatricians' attitudes and perceptions toward do-not-resuscitate (DNR) orders in a specific region of the world not fully explored before. METHODS A cross-sectional study was conducted between March 4 and May 30, 2018. Pediatricians from three public hospitals in the city of Riyadh were asked to respond to a questionnaire consisting of 22 questions designed to meet the objectives of our study. RESULTS A total of 203 pediatricians (51.2% female) completed the questionnaire, both junior pediatricians (JPs) and senior pediatricians (SPs). A majority (58.9% of JPs and 61.4% of SPs) thought patients have the right to demand intensive care, despite their terminal illness. Half the participants in both groups thought that DNR is a physician's decision. Only 9.3% of JPs and 12.5% of SPs felt comfortable discussing DNR with patients/families. Medical school was also a source of knowledge on DNR issues, mainly for JPs (40.2% of JPs vs 20.8% of SPs, P=0.005). Half the participants felt that DNR is consistent with Islamic beliefs, while 57.9% of JPs vs 41.7% of SPs felt they are legally protected. Hospital policy was clear to 48.6% of JPs vs 66.7% of SPs, while procedure was clear to 35.5% of JPs vs 49% of SPs. CONCLUSION Several factors are present that may hinder DNR implementation, such as doubts concerning being legally protected, doubts concerning consistency with Islamic sharia, unclear policies and procedures, and lack of training and orientation on DNR issues. Policies may need to include patients as decision-makers.
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Affiliation(s)
| | | | - Khalid Al-Harbi
- College of Medicine, Al-Imam University, Riyadh, Saudi Arabia
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Al Ahmadi JR, Aljehani SN, Bahakeem LM, Hijan BA, Mayet SA, Badahdah YA. Knowledge and attitude toward do-not-resuscitate among patients and their relatives visiting outpatient clinics at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Saudi Med J 2020; 41:53-58. [PMID: 31915795 PMCID: PMC7001072 DOI: 10.15537/smj.2020.1.24782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To assess knowledge and attitudes about do not resuscitate (DNR) among patients and their relatives visiting outpatient clinics at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Methods: A cross-sectional study conducted between March and April 2018 with a self-administered questionnaire among patients and their relatives visiting outpatient clinics at KAUH. A systematic random selection of individuals every other day. Results: The questionnaire was filled by 400 participants. Fifty-four percent were patients’ relatives, and approximately 60% were female. Out of 105 (26.3%) who were familiar with the DNR term, 44.8% chose the correct definition, 5.2% had previous experience with the DNR term, and 34.3% of them had DNR-related knowledge from social media. Out of the 400 participants, 169 (42.3%) disagreed with DNR. The majority of responders did not know if there is DNR policy or fatwa (a legal opinion on the point of Islamic law). Conclusion: There is a lack of knowledge regarding DNR among participants.
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Affiliation(s)
- Jawaher R Al Ahmadi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Madadin M, Alsaffar GM, AlEssa SM, Khan A, Badghaish DA, Algarni SM, Menezes RG. Clinicians' Attitudes Towards Do-Not-Resuscitate Directives in a Teaching Hospital in Saudi Arabia. Cureus 2019; 11:e6510. [PMID: 31903316 PMCID: PMC6937465 DOI: 10.7759/cureus.6510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Do-Not-Resuscitate (DNR) directive has provided a major leap in end-of-life care. To demonstrate the factors influencing physicians' DNR decisions in King Fahd University Hospital in the Eastern Province of Saudi Arabia, 42 physicians from the medical and surgical departments of the same center were requested to participate in a cross-sectional survey. Thirty-six questionnaires were completed and returned from a total of 42 distributed among physicians, making a response rate of 85.7%. Certain diagnostic categories increase the likelihood of issuing a DNR order for a patient. Neurological (58.3%) and cardiovascular (41.7%) diseases were the highest response among other diseases in influencing physicians' decisions. In addition, other factors like lack of comorbidities (55.5%), age (52.7%), and previous intensive care unit (ICU) admissions and resuscitation (44.4%) showed an effect on the directive decisions of DNR among investigated physicians. However, weak palliative care in the hospital (11.1%), religious beliefs (5.5%), and gender (2.7%) were the least associated factors affecting physicians' DNR decisions. This study addresses the influencing factors of DNR orders issuance among King Fahd Hospital of the University physicians. Physicians noted that cultural standards and religious beliefs do play a role in their decision-making but had less of an effect as compared to other clinical data such as comorbidities, age, and previous ICU admissions.
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Affiliation(s)
- Mohammed Madadin
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Gada M Alsaffar
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Sara M AlEssa
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Afnan Khan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Dania A Badghaish
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Shahad M Algarni
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Kaneetah AH, Baowaidan FO, Abulaban BA, Sabban MF, Alshehri AS. The Perspectives of the General Population and Relatives of Cancer Patients with Respect to the Do-Not-Resuscitate Order. Cureus 2019; 11:e3968. [PMID: 30956920 PMCID: PMC6436887 DOI: 10.7759/cureus.3968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background A do-not-resuscitate (DNR) order is a medical decision that instructs healthcare providers to withhold cardiopulmonary resuscitations (CPR) to patients in case of cardiopulmonary arrest in respect to their wishes. In Saudi Arabia, the decision is usually made by physicians based on the Fatwa number 12086 regardless of the patients' or their families' desires. Assessing the knowledge, perception, and attitude of Saudi family members towards this medical decision may help guide medical practitioners to make decisions that are legally and ethically acceptable for the patients and their family. Therefore, this study aimed to assess their knowledge, perception, and attitude about DNR decisions and to determine demographic variables that affect their attitude towards DNR decisions. Method This cross-sectional study was conducted from December 2017 to January 2018 utilizing survey distribution through emails and different social media outlets including Facebook, Twitter, Pinterest, and LinkedIn. A self-administered questionnaire was employed to elicit responses regarding knowledge, perception, and attitude towards DNR decisions. Statistical Package for the Social Sciences Windows version 17 (SPSS v.17) (IBM Corporation, USA) was used for data management and analysis. Result Of the 1882 participants who filled the questionnaire, only 1693 participants were eligible as the study sample population and were included in the final data analysis. Most of the participants were from the Makkah region (72.2%) and were mainly from the general population (61.66%). Participants were mainly females (66%) and within the median age of 30 years (IQR: 21). As expected, participants who had heard about the DNR practice were from the medical field (58.6%) and they were mainly distant relatives. Almost 76% of the participants had two to four incorrect answers about the DNR practice, and it indicated that participants have inadequate knowledge about a DNR order. Most of the participants (43.2%) refused to be on a DNR order if they were diagnosed with a terminal illness. However, most participants (69.9%) wanted to have an involvement in the decision-making of being on a DNR order. In terms of willingness to understand and learn about the DNR decision, 1475 (87.1%) of the participants wanted to learn more about the DNR practice. Being a relative of a terminally ill cancer patient did not have a significant effect on the knowledge and perceptions of participants about being on a DNR order. However, having a background in medicine was found to be significantly associated with their acceptance to be on a DNR order. The knowledge score regarding DNR was found to be significantly associated with higher acceptance towards DNR orders. Conclusion The majority of participants had a lack of knowledge about the DNR practice. Their religion's concept of hope and virtue is considered as the major reason for their DNR order refusal. However, proper education about the DNR practice and involvement in the DNR order decision-making will increase the participants' knowledge and will improve their acceptance of the DNR practice.
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Affiliation(s)
- Ahmed H Kaneetah
- Internal Medicine, King Abdullah International Medical Research Center - King Saud Bin Abdulaziz University for Health Sciences, Jedah, SAU
| | - Feras O Baowaidan
- Internal Medicine, King Abdullah International Medical Research Center - King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bahaa A Abulaban
- Internal Medcine, King Abdullah International Medical Research Center - King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mahmoud F Sabban
- Internal Medicine, King Abdullah International Medical Research Center - King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ahmad S Alshehri
- Oncology, King Abdullah International Medical Research Center - King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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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; 22:214-222. [PMID: 29743759 PMCID: PMC5930524 DOI: 10.4103/ijccm.ijccm_523_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Alaa Gouda
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, KSA
| | - Norah Alrasheed
- Department of Emergency Care, King Abdulaziz Medical City, Riyadh, KSA
| | - Alaa Ali
- Alfaisal University, College of Medicine, Riyadh, KSA
| | - Ahmad Allaf
- Alfaisal University, College of Medicine, Riyadh, KSA
| | - Najd Almudaiheem
- Princess Nourah Bint Abdulrahman University, College of Medicine, Riyadh, KSA
| | - Youssuf Ali
- Alfaisal University, College of Medicine, Riyadh, KSA
| | - Ahmad Alghabban
- Department of Emergency Care, King Abdulaziz Medical City, Riyadh, KSA
| | - Sami Alsalolami
- Department of Emergency Care, King Abdulaziz Medical City, Riyadh, KSA
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