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Doody O, Davidson H, Lombard J. Do not attempt cardiopulmonary resuscitation decision-making process: scoping review. BMJ Support Palliat Care 2024:spcare-2023-004573. [PMID: 38519106 DOI: 10.1136/spcare-2023-004573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES To conduct a scoping review to explore the evidence of the process of do not attempt cardiopulmonary resuscitation (DNACPR) decision-making. METHODS We conducted a systematic search and review of articles from 1 January 2013 to 6 April 2023 within eight databases. Through multi-disciplinary discussions and content analytical techniques, data were mapped onto a conceptual framework to report the data. RESULTS Search results (n=66 207) were screened by paired reviewers and 58 papers were included in the review. Data were mapped onto concepts/conceptual framework to identify timing of decision-making, evidence of involvement, evidence of discussion, evidence of decision documented, communication and adherence to decision and recommendations from the literature. CONCLUSION The findings provide insights into the barriers and facilitators to DNACPR decision-making, processes and implementation. Barriers arising in DNACPR decision-making related to timing, patient/family input, poor communication, conflicts and ethical uncertainty. Facilitators included ongoing conversation, time to discuss, documentation, flexibility in recording, good communication and a DNACPR policy. Challenges will persist unless substantial changes are made to support and promote examples of good practice. Overall, the review underlined the complexity of DNACPR decision-making and how it is a process shaped by multiple factors including law and policy, resource investment, healthcare professionals, those close to the patient and of central importance, the patient.
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Affiliation(s)
- Owen Doody
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Hope Davidson
- School of Law, University of Limerick, Limerick, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
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Zhong Y, Cavolo A, Labarque V, Gastmans C. Physicians' attitudes and experiences about withholding/withdrawing life-sustaining treatments in pediatrics: a systematic review of quantitative evidence. BMC Palliat Care 2023; 22:145. [PMID: 37773128 PMCID: PMC10540364 DOI: 10.1186/s12904-023-01260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND One of the most important and ethically challenging decisions made for children with life-limiting conditions is withholding/withdrawing life-sustaining treatments (LST). As important (co-)decision-makers in this process, physicians are expected to have deeply and broadly developed views. However, their attitudes and experiences in this area remain difficult to understand because of the diversity of the studies. Hence, the aim of this paper is to describe physicians' attitudes and experiences about withholding/withdrawing LST in pediatrics and to identify the influencing factors. METHODS We systematically searched Pubmed, Cinahl®, Embase®, Scopus®, and Web of Science™ in early 2021 and updated the search results in late 2021. Eligible articles were published in English, reported on investigations of physicians' attitudes and experiences about withholding/withdrawing LST for children, and were quantitative. RESULTS In 23 included articles, overall, physicians stated that withholding/withdrawing LST can be ethically legitimate for children with life-limiting conditions. Physicians tended to follow parents' and parents-patient's wishes about withholding/withdrawing or continuing LST when they specified treatment preferences. Although most physicians agreed to share decision-making with parents and/or children, they nonetheless reported experiencing both negative and positive feelings during the decision-making process. Moderating factors were identified, including barriers to and facilitators of withholding/withdrawing LST. In general, there was only a limited number of quantitative studies to support the hypothesis that some factors can influence physicians' attitudes and experiences toward LST. CONCLUSION Overall, physicians agreed to withhold/withdraw LST in dying patients, followed parent-patients' wishes, and involved them in decision-making. Barriers and facilitators relevant to the decision-making regarding withholding/withdrawing LST were identified. Future studies should explore children's involvement in decision-making and consider barriers that hinder implementation of decisions about withholding/withdrawing LST.
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Affiliation(s)
- Yajing Zhong
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, Block D, box 7001, Leuven, 3000, Belgium.
| | - Alice Cavolo
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, Block D, box 7001, Leuven, 3000, Belgium
| | - Veerle Labarque
- Centre for Molecular and Vascular Biology, Faculty of Medicine, KU Leuven/UZ Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, Block D, box 7001, Leuven, 3000, Belgium
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Alwazzeh MJ, Aljoudi AS, Subbarayalu AV, Alharbi AF, Aldowayan AK, Alshahrani SF, Alamri AM, Almuhanna FA. Knowledge gaps, attitudes, and practices regarding end-of-life medical care among physicians in an academic medical center. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
<b>Introduction:</b> End-of-life medical care (ELMC) plans and do-not-resuscitate (DNR) decision-making are usually affected by multiple factors compared to other medical care decisions.<b> </b>ELMC and DNR policy implementation are still diversified and heterogeneous, especially in Saudi Arabia, because policymakers have adopted no guidelines. Thus, this study investigated physicians’ knowledge, attitude, and practice regarding ELMC and DNR.<br />
<b>Methods:</b> A cross-sectional study design was adopted. Three hundred physicians working at King Fahad Hospital of the University, Khobar, Saudi Arabia, were randomly selected and administered an anonymous self-administered questionnaire using the Likert scale. Data analysis was carried out using SPSS 23.0.<br />
<b>Results: </b>Of 300 distributed questionnaires, 264 (88%) were completed and analysed. Knowledge gaps and negative attitudes were observed, a quarter of the participants were opposed to issuing a DNR order, and 29.0% considered DNR as equal to euthanasia as they practice. The participants’ patient age and religious factors were the most critical factors in the ELMC plan and DNR decision. The physician’s level of acceptance regarding a set of ELMC interventions and DNR decisions showed heterogenicity and uncertainty among participants.<br />
<b>Conclusions:</b> The ELMC plan and DNR decision-making should be appropriately addressed in the medical residents’ training programs to bridge the knowledge gap and the physicians’ negative attitudes during their practice. Additionally, there is a need to update and unify the DNR policies at the national level, considering the patient’s right to be informed and involved actively during the decision process making. Finally, more prospective research is needed for the global standardization of ELMC.
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Affiliation(s)
- Marwan Jabr Alwazzeh
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
- King Fahad Hospital of the University, Al-Khobar, SAUDI ARABIA
| | - Abdullah Srour Aljoudi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Arun Vijay Subbarayalu
- Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Abdulelah Fawzi Alharbi
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Ali Khalid Aldowayan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Saad Falah Alshahrani
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Ali Mohammad Alamri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
- King Fahad Hospital of the University, Al-Khobar, SAUDI ARABIA
| | - Fahd Abdulaziz Almuhanna
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
- King Fahad Hospital of the University, Al-Khobar, SAUDI ARABIA
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Woodman A, Waheed KB, Rasheed M, Ahmad S. Current state of ethical challenges reported in Saudi Arabia: a systematic review & bibliometric analysis from 2010 to 2021. BMC Med Ethics 2022; 23:82. [PMID: 35964019 PMCID: PMC9375198 DOI: 10.1186/s12910-022-00816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Over the past few years, five domains of importance about the current state of bioethics in Saudi Arabia have shaped the perspective of most research: doctor-patient relationship, informed consent, do-not-resuscitate, organ donation, and transplantation, medical students’ knowledge and attitudes about medical ethics curriculum. This systematic review aimed to systematically identify, compile, describe and discuss ethical arguments and concepts in the best-studied domains of bioethics in Saudi Arabia and to present cultural, social, educational, and humane perspectives.
Methods Six databases were searched using Boolean operators (PubMed, Embase, Web of Science, Scopus, CINAHL, Google Scholar) from December 2020–June 2021. The search and report process followed the statement and flowchart of preferred reporting items for systematic reviews and meta-analyses (PRISMA). Resutls The search resulted in 1651 articles, of which 82 studies were selected for a final review and assessment. There is a gradual increase in research, whereby a substantial increase was observed from 2017. Most of the published articles focused on ‘Organ Donation & Transplantation’ with 33 articles, followed by ‘Doctor-Patient Relations’ with 18 publications. Most of the published articles were from Central Province (33), followed by Western Province (16). The authorship pattern showed a collaborative approach among researchers. The thematic analysis of keywords analysis showed that ‘Saudi Arabia,’ ‘attitude PHC,’ ‘organ donation,’ ‘knowledge and education,’ and ‘donation’ have been used the most commonly. Conclusion This systematic quantitative synthesis is expected to guide researchers, stakeholders, and policymakers about the strengths and gaps in knowledge and attitudes regarding medical ethics in Saudi Arabia, both among the general public and health professionals.
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Affiliation(s)
- Alexander Woodman
- Yale Interdisciplinary Center for Bioethics, Yale University, New Haven, CT, USA.
| | - Khawaja Bilal Waheed
- Radiodiagnostic and Imaging Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mohammad Rasheed
- Vice Deanship of Postgraduate Studies and Research, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Shakil Ahmad
- Deanship of Library Affairs, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Zhong Y, Cavolo A, Labarque V, Gastmans C. Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence. BMC Palliat Care 2022; 21:113. [PMID: 35751075 PMCID: PMC9229823 DOI: 10.1186/s12904-022-01003-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background With paediatric patients, deciding whether to withhold/withdraw life-sustaining treatments (LST) at the end of life is difficult and ethically sensitive. Little is understood about how and why physicians decide on withholding/withdrawing LST at the end of life in paediatric patients. In this study, we aimed to synthesise results from the literature on physicians’ perceptions about decision-making when dealing with withholding/withdrawing life-sustaining treatments in paediatric patients. Methods We conducted a systematic review of empirical qualitative studies. Five electronic databases (Pubmed, Cinahl®, Embase®, Scopus®, Web of Science™) were exhaustively searched in order to identify articles published in English from inception through March 17, 2021. Analysis and synthesis were guided by the Qualitative Analysis Guide of Leuven. Results Thirty publications met our criteria and were included for analysis. Overall, we found that physicians agreed to involve parents, and to a lesser extent, children in the decision-making process about withholding/withdrawing LST. Our analysis to identify conceptual schemes revealed that physicians divided their decision-making into three stages: (1) early preparation via advance care planning, (2) information giving and receiving, and (3) arriving at the final decision. Physicians considered advocating for the best interests of the child and of the parents as their major focus. We also identified moderating factors of decision-making, such as facilitators and barriers, specifically those related to physicians and parents that influenced physicians’ decision-making. Conclusions By focusing on stakeholders, structure of the decision-making process, ethical values, and influencing factors, our analysis showed that physicians generally agreed to share the decision-making with parents and the child, especially for adolescents. Further research is required to better understand how to minimise the negative impact of barriers on the decision-making process (e.g., difficult involvement of children, lack of paediatric palliative care expertise, conflict with parents). Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01003-5.
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Affiliation(s)
- Yajing Zhong
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, block D, box 7001, 3000, Leuven, Belgium.
| | - Alice Cavolo
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, block D, box 7001, 3000, Leuven, Belgium
| | - Veerle Labarque
- Centre for Molecular and Vascular Biology, Faculty of Medicine, KU Leuven/UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, block D, box 7001, 3000, Leuven, Belgium
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Brummett A, Muaygil R. Phenomenology, Saudi Arabia, and an argument for the standardization of clinical ethics consultation. Philos Ethics Humanit Med 2021; 16:1. [PMID: 33706761 PMCID: PMC7953697 DOI: 10.1186/s13010-021-00099-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The purpose of this study is to make a philosophical argument against the phenomenological critique of standardization in clinical ethics. We used the context of clinical ethics in Saudi Arabia to demonstrate the importance of credentialing clinical ethicists. METHODS Philosophical methods of argumentation and conceptual analysis were used. RESULTS We found the phenomenological critique of standardization to be flawed because it relies on a series of false dichotomies. CONCLUSIONS We concluded that the phenomenological framing of the credentialing debate relies upon two extreme views to be navigated between, not chosen among, in the credentialing of clinical ethicists.
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Affiliation(s)
- Abram Brummett
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 3331 Squirrel Court, Auburn Hills, MI 48326 USA
| | - Ruaim Muaygil
- College of Medicine, King Saud University and King Saud University Medical City, 6877 Ibrahim Ibn Hadi, Riyadh, 12476 Saudi Arabia
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