Emergency Department, Aga Khan University Hospital, Karachi, Sindh, Pakistan
Emergency Department, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
BMJ Open. 2020 Sep 14;10(9):e038915. doi: 10.1136/bmjopen-2020-038915.
Do not resuscitate (DNR) decision making is an integral component of emergency medicine practice. There is a paucity of data, protocols and guidelines regarding the perceptions and barriers that are involved in the interactions among healthcare professionals, patients and their caregivers regarding DNR decision making. The aim of this study is, therefore, to explore the perceptions and factors influencing DNR decision making in the emergency department and to evaluate the use of a context-based protocol for DNR decision making.
This will be a sequential mixed method study beginning with qualitative research involving in-depth interviews (IDIs) with patient family members and focus group discussion with healthcare professionals. The consensual qualitative approach will be used to perform a thematic analysis to the point of saturation. The expected outcome will be to identify key themes that suggest perceptions and factors involved in DNR decision making. After piloting, the derived protocol will then be used with a different group of individuals (150 healthcare professionals) who meet the eligibility criteria in a quantitative cross-sectional study with universal sampling. Data will be analysed using NVIVO in the qualitative phase and SPSS V.19 in the quantitative phase. The study findings will support the development of a standardised protocol for DNR decision making for healthcare professionals in the emergency department.
The proposal was reviewed by the ethics review committee (ERC) of the institution (ERC # 2020-1551-7193). The project is an institution SEED grant recipient PF139/0719. The results will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations, brochures and emails. The findings will be published in a highly accessed peer-reviewed medical journal and will be presented at international conferences.
不复苏（DNR）决策是急诊医学实践的一个组成部分。关于医疗保健专业人员、患者及其护理人员在 DNR 决策方面的相互作用的看法和障碍，数据、协议和指南都很缺乏。因此，本研究的目的是探讨在急诊科进行 DNR 决策的看法和影响因素，并评估基于情境的 DNR 决策协议的使用。
这将是一项顺序混合方法研究，首先进行定性研究，包括对患者家属进行深入访谈（IDIs）和对医疗保健专业人员进行焦点小组讨论。将使用共识定性方法对达到饱和点的主题进行分析。预期结果将确定涉及 DNR 决策的看法和因素的关键主题。经过试点后，然后将在一项具有普遍性抽样的定量横断面研究中，用不同的一组符合资格标准的个体（150 名医疗保健专业人员）试用该协议。将使用 NVIVO 在定性阶段和 SPSS V.19 在定量阶段分析数据。研究结果将支持为急诊科的医疗保健专业人员制定 DNR 决策的标准化协议。
该提案已由机构伦理审查委员会（ERC）审查（ERC # 2020-1551-7193）。该项目是机构 SEED 资助的获得者 PF139/0719。研究结果将通过研讨会、演讲、宣传册和电子邮件在参与者、患者社区和机构内的医疗保健专业人员中进行传播。研究结果将发表在高访问量的同行评议医学期刊上，并将在国际会议上展示。
