Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives
High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitude...
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| description | High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.
Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.
Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).
In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p |
| doi_str_mv | 10.1371/journal.pone.0098246 |
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Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.
Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).
In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for "full code" even if terminally ill and were less supportive of organ donation.
Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0098246</identifier><identifier>PMID: 24869673</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Advance directives ; Advance Directives - psychology ; Age Factors ; Area Under Curve ; Attitude of Health Personnel ; Attitudes ; Blood & organ donations ; Cancer therapies ; Chronic illnesses ; Cohort Studies ; Do-not-resuscitate orders ; Doctors ; End of life ; Health care facilities ; Health care policy ; Humans ; Intensive care ; Medical personnel ; Medical prognosis ; Medical schools ; Medicine ; Medicine - statistics & numerical data ; Medicine and Health Sciences ; Metastasis ; Minority & ethnic groups ; Organ donors ; Palliative care ; Patients ; Personal health ; Physicians ; Physicians - psychology ; Resuscitation ; Resuscitation Orders - psychology ; Surgeons ; Surveys ; Terminal Care - psychology ; Tissue donation</subject><ispartof>PloS one, 2014-05, Vol.9 (5), p.e98246</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014. This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-8a1134d40fabcf6ea2b71f91e8d0f434fa0c24026bae6485dd8d90f716ddbcd23</citedby><cites>FETCH-LOGICAL-c692t-8a1134d40fabcf6ea2b71f91e8d0f434fa0c24026bae6485dd8d90f716ddbcd23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037207/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037207/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24869673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Eldabe, Sam</contributor><creatorcontrib>Periyakoil, Vyjeyanthi S</creatorcontrib><creatorcontrib>Neri, Eric</creatorcontrib><creatorcontrib>Fong, Ann</creatorcontrib><creatorcontrib>Kraemer, Helena</creatorcontrib><title>Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.
Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.
Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).
In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for "full code" even if terminally ill and were less supportive of organ donation.
Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.</description><subject>Advance directives</subject><subject>Advance Directives - psychology</subject><subject>Age Factors</subject><subject>Area Under Curve</subject><subject>Attitude of Health Personnel</subject><subject>Attitudes</subject><subject>Blood & organ donations</subject><subject>Cancer therapies</subject><subject>Chronic illnesses</subject><subject>Cohort Studies</subject><subject>Do-not-resuscitate orders</subject><subject>Doctors</subject><subject>End of life</subject><subject>Health care facilities</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Medical personnel</subject><subject>Medical prognosis</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine - statistics & numerical data</subject><subject>Medicine and Health Sciences</subject><subject>Metastasis</subject><subject>Minority & ethnic groups</subject><subject>Organ donors</subject><subject>Palliative care</subject><subject>Patients</subject><subject>Personal health</subject><subject>Physicians</subject><subject>Physicians - 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This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.
Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.
Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).
In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for "full code" even if terminally ill and were less supportive of organ donation.
Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24869673</pmid><doi>10.1371/journal.pone.0098246</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Advance directives Advance Directives - psychology Age Factors Area Under Curve Attitude of Health Personnel Attitudes Blood & organ donations Cancer therapies Chronic illnesses Cohort Studies Do-not-resuscitate orders Doctors End of life Health care facilities Health care policy Humans Intensive care Medical personnel Medical prognosis Medical schools Medicine Medicine - statistics & numerical data Medicine and Health Sciences Metastasis Minority & ethnic groups Organ donors Palliative care Patients Personal health Physicians Physicians - psychology Resuscitation Resuscitation Orders - psychology Surgeons Surveys Terminal Care - psychology Tissue donation |
| title | Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives |
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