Department of Oncology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 7, DK-2730, Herlev, Denmark.
Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
Support Care Cancer. 2020 Dec;28(12):6057-6066. doi: 10.1007/s00520-020-05460-7. Epub 2020 Apr 15.
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.
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.
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.
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.
在重病患者中做出不复苏（DNR）决策带来了许多医学、伦理和法律方面的难题。本研究的主要目的是探讨癌症患者和医疗保健专业人员对 DNR 决策权限和决策时机的态度。
本研究采用问卷调查的方式，在肿瘤门诊环境中调查丹麦癌症患者及其主治医生和护士。使用 Fisher 确切检验分析患者、医生和护士对问卷回答的潜在差异。
分析了 904 名患者、59 名医生和 160 名护士的回复。这三组人群中的大多数人都认为 DNR 决策应由医生和患者共同做出。然而，三分之一的患者回答说，应该由患者独自决定 DNR，这与医生和护士的态度形成对比，他们分别有 0%和 6%的人认为患者应该是唯一的决策者。如果患者和医生意见不一致，大多数患者（66%）和医生（86%）都认为自己应该是最终的决策者。此外，43%的患者希望在疾病早期就开始讨论 DNR，而只有 19%的医生希望这样做。
在患者与医生的决策角色以及 DNR 讨论的时机方面，我们发现癌症患者和医生的态度存在很大差异。这种差异呼吁医疗保健专业人员和公众更加关注和讨论这一敏感话题。
