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QJM Advance Access published online on September 6, 2006
QJM, doi:10.1093/qjmed/hcl096
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received March 3, 2006
Accepted June 19, 2006

Original Papers

Experiences and views of specialist registrars in geriatric medicine on ‘do not attempt resuscitation’ decisions: a sea of uncertainty?

P.K. Myint 1 *, S. Miles 2, D.A. Halliday 3, and L.K. Bowker 4

1 From the Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK; From the School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK; From the Clinical Gerontology Unit & Lewin Stroke Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
2 From the School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
3 From the East of England Research and Development Support Unit--Norfolk and Suffolk, University of East Anglia, Norwich, UK
4 From the Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK; From the School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

* To whom correspondence should be addressed.
P.K. Myint, E-mail: pkyawmyint{at}aol.com


  Abstract

Background: Recent cultural changes place doctors under increasing pressure to work with their patients to reach decisions about end-of-life care.

Aim: To survey the experience, practice and opinions of specialist registrars (SPRs) in geriatric medicine regarding ‘do not attempt resuscitation’ (DNAR) decisions.

Design: Postal questionnaire survey.

Methods: A questionnaire was mailed to all members registered as trainees (n = 408) with the British Geriatrics Society in November 2003; a reminder was sent nine weeks later. Responses were analysed using both quantitative and qualitative (thematic) approaches.

Results: Response rate was 62% (251/408), of whom 235 were still SpRs. Respondents played a major role in DNAR decision-making in their day-to-day clinical practice. Over a third of respondents did not feel that locally available guidelines were helpful. More than half sometimes disagreed with their consultants’ decision, and a fifth were concerned about the possibility of complaints regarding the decisions they made. The majority felt uncomfortable discussing the issue with the patient, and were more likely to discuss the issue with relatives than with patients.

Discussion: Further support and training may improve confidence and positive experiences in relation to DNAR decision-making among training-grade doctors in the UK.


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