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UK doctors ‘less likely’ to resuscitate the most seriously ill patients since Covid
Pandemic may have changed decision-making, according to research
published in Journal of Medical Ethics
A hospital patient with a ‘do not resuscitate’ band
The survey suggested doctors would be less willing to resuscitate very
sick or frail patients and may raise the threshold for referral to
intensive care. Photograph: Peter Dazeley/Getty Images
Andrew Gregory Health editor
Mon 25 Jul 2022 18.30 EDT
Doctors are less likely to resuscitate the most seriously ill patients
in the wake of the pandemic, a survey suggests.
Covid-19 may have changed doctors’ decision-making regarding end of
life, making them more willing not to resuscitate very sick or frail
patients and raising the threshold for referral to intensive care,
according to the results of the research published in the Journal of
Medical Ethics.
However, the pandemic has not changed their views on euthanasia and doctor-assisted dying, with about a third of respondents still strongly
opposed to these policies, the survey responses reveal.
The research found that 59% of patients with a DNACPR decision survived
their acute illness.
Third of UK hospital Covid patients had ‘do not resuscitate’ order in
first wave
Read more
The Covid-19 pandemic transformed many aspects of clinical medicine,
including end-of-life care, prompted by millions more patients than
usual requiring it around the world, say the researchers.
The survey sought to find out if it has significantly changed how
doctors make end-of-life decisions, specifically in respect of do not
attempt cardio-pulmonary resuscitation (DNACPR) notices and treatment escalation to intensive care. Researchers also wanted to know if the
pandemic had changed doctors’ views on euthanasia and doctor-assisted suicide.
The survey was open to doctors of all grades and specialties in the UK
between May and August 2021. In all, 231 responded: 15 from foundation
year 1 junior doctors (6.5%); 146 from senior junior doctors (SHOs)
(63%); 42 from hospital specialty trainees or equivalent (18%); 24 from consultants or GPs (10.5%); and 4 others (2%).
In respect of DNACPR, the decision not to attempt to restart a patient’s heart when it or breathing stops, more than half the respondents were
more willing to do this than they had been previously.
When the responses were weighted to represent the different medical
grades in the NHS national workforce, the results were: “significantly less” 0%; “somewhat less” 2%; “same or unsure” 35%; “somewhat more”
41.5%; “significantly more” 13%; and “not applicable” 8.5%.
We doctors must learn from what went wrong with 'do not resuscitate' orders Rachel Clarke
Rachel Clarke
Read more
Asked about the contributory factors, the most frequently cited were:
“likely futility of CPR” (88% pre-pandemic, 91% now): coexisting
conditions (89% both pre-pandemic and now): and patient wishes (83.5% pre-pandemic, 80.5% now). Advance care plans and “quality of life” after resuscitation were also commonly cited.
The number of respondents who said “patient age” was a major factor informing their decision grew from 50.5% pre-pandemic to about 60%. And
the proportion who cited a patient’s frailty rose by 15 percentage
points from 58% pre-pandemic to 73%.
The biggest change, however, was in those citing “resource limitation”, which increased by 20 percentage points, from 2.5% to 22.5%.
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When asked whether the thresholds for escalating patients to intensive
care or providing palliative care had changed, the largest proportion
said the “same or unsure”: 46% (weighted) for referral; 64.5% (weighted) for palliative care.
But a substantial minority said that they now had a higher threshold for referral to intensive care (22.5% weighted) and a lower threshold for palliation (18.5% weighted).
“What is yet to be determined is whether these changes will now stay the
same indefinitely, revert back to pre-pandemic practices, or evolve even further,” the researchers concluded.
When it came to euthanasia and doctor-assisted suicide, the responses
showed the pandemic has led to marginal, but not statistically
significant, changes of opinion.
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