Ethics

Physicians’ confidence in discussing do not resuscitate orders with patients and surrogates

¹ The John J Conley, Department of Ethics, St. Vincent’s Manhattan, New York, USA
² The Section of Palliative Care, Department of Medicine, St. Vincent’s Manhattan, New York, USA
³ The Bioethics Institute of New York Medical College, Valhalla, New York, USA

Correspondence to:
Dr D P Sulmasy, John J Conley Department of Ethics, St. Vincent’s Hospital Manhattan 153 W. 11th St. New York, NY 10011, USA; daniel_sulmasy{at}nymc.edu

Purpose: Physicians are often reluctant to discuss "Do Not Resuscitate" (DNR) orders with patients. Although perceived self-efficacy (confidence) is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.

Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.

Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures (p<0.001), and this was true for both attendings (p = 0.002) and housestaff (p<0.001). In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men (OR = 0.52, CI = 0.29 to 0.92); house officers were less confident than attendings (OR = 0.35, CI = 0.20 to 0.61), those who were less confident of their ability to discuss medical procedures were less confident discussing DNR (OR = 0.12, CI = 0.06 to 0.25), and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not (OR = 0.06, CI = 0.02 to 0.16).

Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics.

Keywords: Ethics; house officers; confidence; communication; do not resuscitate

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