Assessing Medical Students' Understanding of Do-Not-Resuscitate (DNR) Orders

The evolution of medical directives surrounding cardiopulmonary resuscitation (CPR) has led to the prominence of do-not-resuscitate (DNR) orders. These orders aim to respect patient autonomy and ensure dignified end-of-life care. While regulations in the United States emphasize patient choice and comprehensive discussions, Saudi Arabia's approach to DNR orders integrates Islamic principles alongside expert medical judgment. This study aimed to assess the awareness and comprehension of DNR orders among medical students at Umm Al-Qura University, Makkah, Saudi Arabia.

This study employed a cross-sectional design at Umm Al-Qura University in 2023. Convenience sampling yielded a sample of 145 participants, encompassing medical students from all years (first-sixth) and medical interns. A self-administered online questionnaire assessed participants' knowledge, beliefs, and attitudes regarding DNR orders. The questionnaire specifically addressed their familiarity with DNR orders, their understanding of the Islamic perspective on DNR, and the factors influencing their attitudes toward DNR.  Results: The majority of respondents (62%) were familiar with the term "DNR," but only 52% correctly defined it. Social media was the primary source of information about DNR for most respondents (56%). A significant portion of respondents (60.7%) agreed with the concept of DNR, and 54% had personal experience with the term. Patient dignity (54%), religious concerns (66.7%), and legal concerns (60.7%) were identified as important factors in DNR decisions. A majority of respondents (67%) agreed that it is acceptable to discontinue life support for DNR patients, and 49.3% believed that organ donation should be encouraged among patient families. The study found that as medical students progressed through their training (from pre-clinical to clinical years and internship), their acceptance and understanding of DNR orders generally increased.

The study found that medical students possess some basic familiarity with DNR orders, but there is considerable room for advancement in their comprehension and acceptance of the topic. Addressing these knowledge gaps may lead to improved patient outcomes. The findings also underscore the need to equip future physicians with a comprehensive understanding of DNR orders, their ethical ramifications, and effective communication strategies for engaging with patients and their families.