Problems Experienced by Health Care Professionals with Do not Attempt Resuscitation (DNAR) Orders - A Qualitative...

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Healthcare Management

Background:

• Do Not Attempt Resuscitation (DNAR) orders are critical yet challenging medical decisions.
• European guidelines exist, but healthcare professionals (HCPs) report difficulties in DNAR order implementation.
• Understanding these challenges is crucial for improving end-of-life care communication.

Purpose of the Study:

• To evaluate the specific problems encountered by HCPs in making DNAR orders.
• To identify deficits in decision support according to the Ottawa Decision Support Framework.
• To inform the development of better support systems for DNAR decision-making.

Main Methods:

• A web-based questionnaire with open-ended questions was distributed to physicians and nurses.
• Data from 648 respondents were analyzed using qualitative methods (Atlas.ti software).
• Responses were categorized based on the Ottawa Decision Support Framework and expanded decisional needs.

Main Results:

• 599 statements identified issues related to inadequate advice, information, emotional support, and instrumental help.
• HCPs experience a lack of support across multiple levels of DNAR decision-making.
• Qualitative analysis revealed significant unmet needs in the DNAR process.

Conclusions:

• Healthcare professionals require enhanced support for DNAR order decisions.
• Digital decision-making support integrated into electronic patient records (EPR) is proposed.
• Timely and visible DNAR orders can be facilitated through improved digital tools.