Aljohaney Ahmed, Bawazir Yasser
Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Adv Med Educ Pract. 2015 May 26;6:393-8. doi: 10.2147/AMEP.S82948. eCollection 2015.
The purpose of this study was to analyze the perceptions and practices of internal medicine residents in the western region of Saudi Arabia regarding the implementation of do not resuscitate (DNR) orders to improve future training practices among physicians.
Medical residents involved in training programs in the western region of Saudi Arabia, including Jeddah, Makah, Medinah, and Taif, were invited to participate in a cross-sectional, anonymous, online survey regarding DNR orders. The 16-question survey was distributed to residents in all training programs in the region using surveymonkey.com, and the results were collected and tabulated.
Of 364 residents, 157 completed the questionnaire, resulting in a 43% response rate. The study showed that most (66%) internal medicine residents in the western region of Saudi Arabia participate in DNR discussions with patients and family or surrogate decision-makers. In addition, 43% were observed by faculty members, and half of them (51.9%) reported feeling comfortable during these discussions. Furthermore, most residents believed that additional educational programs would enhance their competence in addressing issues related to DNR discussions.
This study highlights the need for a structured curriculum to teach skills relating to end-of-life issues such as DNR orders to residents in the Saudi Arabian medical system. The majority of residents surveyed believe they would benefit from additional training in DNR discussions. Therefore, an evidence-based curriculum providing instruction for improving discussions regarding DNR orders would improve physician confidence and effectiveness in caring for critically ill patients.
本研究旨在分析沙特阿拉伯西部地区内科住院医师对于实施“不要复苏”（DNR）医嘱的认知和实践情况，以改进未来医生的培训实践。
邀请参与沙特阿拉伯西部地区（包括吉达、麦加、麦地那和塔伊夫）培训项目的医学住院医师参加一项关于DNR医嘱的横断面、匿名在线调查。通过surveymonkey.com将这份包含16个问题的调查问卷分发给该地区所有培训项目的住院医师，并收集结果进行列表统计。
在364名住院医师中，157人完成了问卷，回复率为43%。研究表明，沙特阿拉伯西部地区大多数（66%）内科住院医师参与了与患者及其家属或替代决策者关于DNR的讨论。此外，有43%的住院医师被教员观察过，其中一半（51.9%）表示在这些讨论中感到自在。此外，大多数住院医师认为额外的教育项目将提高他们处理与DNR讨论相关问题的能力。
本研究强调在沙特阿拉伯医疗系统中，需要为住院医师制定结构化课程，教授与诸如DNR医嘱等临终问题相关的技能。大多数接受调查的住院医师认为他们将从DNR讨论的额外培训中受益。因此，提供关于改进DNR医嘱讨论指导的循证课程将提高医生照顾重症患者的信心和效率。
