Factors in oncologists' attitudes on do-not-attempt-resuscitation orders for patients with cancer

Discussions on do-not-attempt-resuscitation (DNAR) orders are considered critical end-of-life discussions with patients with advanced cancer; however, patients are not necessarily involved in these discussions. Therefore, we aimed to clarify oncologists' practice, perceptions, values, and attitudes regarding DNAR orders and to identify factors associated with oncologists' attitudes toward confirming patients' preference for DNAR orders.

Oncologists in designated cancer hospitals in Japan were surveyed using a self-administered questionnaire. Multivariate analyses were performed to identify attributes to attitudes toward confirmation of patients' preferences.

Among 688 participating oncologists, 477 (69%) indicated that they would confirm patients' preferences when issuing a DNAR order if they were competent. Independent variables for positive attitudes toward confirming patients' preferences before issuing DNAR orders included "Talking about DNAR is severely distressing for family" (Odds ratio (OR) = 2.459, p < 0.001) and "It is burdensome to prepare for discussions regarding DNAR orders" (OR = 1.450, p = 0.002) and the value "Non-maleficence" (OR = 1.384, p = 0.012). On the other hand, independent variables for negative attitudes included "Patients do not need to know about DNAR if their family members know about it" (OR = 0.329, p < 0.001) and "Talking about DNAR orders is severely distressing for patients" (OR = 0.443, p ≤ 0.001) and the values "Preference of family" (OR = 0.687, p = 0.012), "Lack of training and education on discussing DNAR orders," (OR = 0.731, p = 0.006), and "It is hard to talk about death" (OR = 0.758, p = 0.026).

Oncologists' discomfort talking about death and their perceived distress for patients and their families were associated with their attitudes towards discussions about DNAR orders.