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Discussion of the do-not-resuscitate (DNR) orders with the family caregivers of cancer patients: An example from a major cancer center in Saudi Arabia

Published online by Cambridge University Press:  21 December 2023

Mohammad Z. Al-Shahri Open the ORCID record for Mohammad Z. Al-Shahri [Opens in a new window] ,
Mahmoud Sroor Open the ORCID record for Mahmoud Sroor [Opens in a new window] ,
Wael Ali Said Ghareeb Open the ORCID record for Wael Ali Said Ghareeb [Opens in a new window] ,
Suzan Alhassanin Open the ORCID record for Suzan Alhassanin [Opens in a new window]  and
Heba Aly Ateya Open the ORCID record for Heba Aly Ateya [Opens in a new window]
Mohammad Z. Al-Shahri*
Affiliation:
Palliative Care Medicine, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Mahmoud Sroor
Affiliation:
Palliative Care Medicine, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Kaser Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kaser El-Aini School of Medicine, Cairo University, Cairo, Egypt
Wael Ali Said Ghareeb
Affiliation:
Palliative Care Medicine, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Suzan Alhassanin
Affiliation:
Palliative Care Medicine, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Clinical Oncology Department, Menoufia University, Shebin Elkom, Egypt
Heba Aly Ateya
Affiliation:
Palliative Care Medicine, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia National Cancer Institute, Cairo University, Cairo, Egypt
*
Corresponding author: Mohammad Z. Al-Shahri; Email: [email protected]
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Abstract

Objectives

To explore the views of the family caregivers (FCGs) about the “do-not-resuscitate” (DNR) discussions and decision-making processes that occurred during hospitalization in a Saudi cancer center.

Methods

In this cross-sectional survey, the FCGs of inpatients with advanced cancer completed a self-administered questionnaire soon after giving the patients a DNR status designation by their oncologists.

Results

Eighty-two FCGs participated in the study, with a median age of 36.5 years and male preponderance (70.7%). The FCGs were mostly sons (41.5%), daughters (14%), or brothers (11%) of patients. Only 13.4% of mentally competent patients had the chance to listen to the DNR discussion. The discussion mainly occurred in the ward corridor (48.8%) or another room away from the patients’ rooms (35.4%). In 36.6% of cases, the discussion took ≤5 minutes. Half of the FCGs stated that the oncologists’ justifications for the DNR decision were unconvincing. The majority (84.2%) of the FCGs felt that the healthcare providers should share the DNR decision-making with patients (1.2%), families (69.5%), or both (13.4%). FCGs ≤ 30 years of age were more supportive of giving patients’ families a chance to participate in the DNR decision-making process (p = 0.012).

Significance of results

There is considerable room for improving the current practice of DNR discussions and decision-making processes in the studied setting. A readily feasible rectifying measure is to ensure the adequacy of time and privacy when planning for DNR discussions. We expect our findings to draw the attention of stakeholders to a compelling need for reviewing the current policies and processes, aiming to improve the experience of cancer patients and their FCGs.

Keywords

Do-not-resuscitate (DNR) discussionbreaking bad newsend-of-life carefamily caregiverpalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 3 , June 2024 , pp. 511 - 516
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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