Attitudes towards do-not-resuscitate decisions: differences among health professionals in a Portuguese hospital

Objectives: Implementation of an in-hospital cardiopulmonary resuscitation (CPR) program stresses the need to discuss do-not-resuscitate (DNR) orders, as CPR may not be desirable in some terminally ill patients. Ethical, social, educational, and professional issues may influence these decisions. This study was designed to evaluate attitudes among four categories of healthcare professionals. Design and setting: Survey in a tertiary hospital in Portugal. Methods: An anonymous self-completed questionnaire was distributed to 825 staff members, 527 of whom responded (20 % physicians, 44 % nurses, 20 % health technicians, 16 % healthcare domestic staff). Responses were compared between the various health professional groups. Results: The level of medical/health training was positively related to the frequency of DNR decisions (physicians and nurses could foresee more circumstances warranting DNR decisions than technical/administrator or domestic staff) and negatively related to the willingness to include the patient's family in the DNR decision (physicians and nurses saw less need for the family's participation than technical/administrator or domestic staff). Significant differences were also found between professional groups regarding the physician's responsibility and the nurses' participation in DNR decisions. There was no difference between the professional groups regarding the need to note the DNR decision in clinical charts. Conclusion: Health professionals differ in their attitudes concerning DNR decisions. In particular, the level of medical/health training and/or degree of involvement with the patient's daily care may play an important role in DNR decisions.