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Cited by 33Palliative Care and End-of-Life IssuesCardiac Arrest and ResuscitationEthics and bioethics in healthcare

Themes and variations: An exploratory international investigation into resuscitation decision-making

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Gibbs, Alexander J.O., Malyon, Alexandra C., Fritz, Zoë B. McC·2016·Resuscitation
DOI 10.1016/j.resuscitation.2016.01.020PMC PMC4879149
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Abstract

BACKGROUND: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are made in hospitals throughout the globe. International variation in clinicians' perception of DNACPR decision-making and implementation and the factors influencing such variation has not previously been explored. METHODS: A questionnaire asking how DNACPR decisions are made, communicated and perceived in their country was composed: it consisted of seven closed-answer and four open-answer questions. It was distributed to 143 medical professionals with prior published material relating to DNACPR decisions. Under-represented geographical areas were identified and an additional 34 physicians were contacted through medical colleagues and students at the university hospital from which this study was based. The respondents had 4 weeks to answer the questionnaire. RESULTS: 78 responses (44%) were received from 43 countries. All continents were represented. 88% of respondents reported a method for implementing DNACPR decisions, 90% of which discussed resuscitation wishes with the patient at least half of the time. 94% of respondents thought that national guidance for DNACPR order implementation should exist; 53% of countries surveyed reported existence of such guidance. Cultural attitudes towards death, medical education and culture, health economics and the societal role of family were commonly identified as factors influencing perception of DNACPR decisions. CONCLUSIONS: The majority of countries surveyed make some form of DNACPR decision but differing cultures and economic status contribute towards a heterogeneity of approaches to resuscitation decision-making. Adequacy of relevant medical education and national policy are two areas that were regularly identified as impacting upon the processes of DNACPR decision-making and implementation.

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  • There was a strong emphasis on the need for a clear DNACPR policy with 98%, 94%, 74% of samples reporting the need for policy and that there should be legislation regarding DNACPR.

    “There was a strong emphasis on the need for a clear DNACPR policy with 98%,65 94%,17 74%60 of their samples reporting the need for policy and that there should be legislation regarding DNACPR.65”

    From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [17]

    The Results (Making a DNACPR decision; page not provided) report that 94% of respondents favored national policy or guidance, supporting the general emphasis on a clear policy. The paper does not report 98% favoring a policy or respondents calling for DNACPR legislation; its Discussion (Politico-legal; page not provided) discusses legal ambiguity but not such a recommendation. (LLM, conf=0.88)

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  • Healthcare professionals thought it important that the care team would be informed of the DNACPR decision and that the decision would be clearly documented; 87% worked in a hospital where there was a method for communicating decisions to their medical colleagues.

    “Healthcare professionals thought it important that the care team would be informed of the decision and that the decision would be clearly documented46 and 87% worked in a hospital where there was a method for communicating decisions to their medical colleagues.17”

    From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [17]

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  • Gibbs et al spanned across 43 countries in total.

    “In one study, Gibbs et al17 spanned across 43 countries in total and was counted separately.”

    From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [17]

  • Culture and religion are factors that can influence DNACPR decision making.

    “culture and religion are factors that can influence decision making,17 55 56”

    From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [17]

  • Religion was a clear factor in the decision in countries with strong religious majorities.

    “Similarly, religion was a clear factor in the decision in countries with strong religious majorities.17 55 56”

    From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [17]

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Authors
Gibbs, A. J. O., Malyon, A. C., & Fritz, Z. B. M.
Affiliations
  • University of Cambridge (GB)
  • Cambridge University Hospitals NHS Foundation Trust (GB)
Corresponding author
Fritz, Zoë B. McC
ORCID
Venue
Resuscitation
Publisher
Elsevier BV
Published
2016-06
Volume
103
Pages
75-81
ISSN
0300-9572 (ISSN-L)
DOI
10.1016/j.resuscitation.2016.01.020
PMC
PMC4879149
OpenAlex
W2294254407
Cited by
33
References
0
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 7 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 1
FWCI
1.65
Type
journal article
Language
en
Open access
Licence
Locations
  • Resuscitation (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Wellcome Trust Fellowship (WT100557MA)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
DNACPR, international variation, patient consent, medical education, health economics, physician perceptions
MeSH terms
Attitude of Health Personnel, Attitude to Death, Communication, Decision Making, Humans, Physicians, Surveys and Questionnaires, Terminal Care, Resuscitation Orders, Cardiopulmonary Resuscitation, Practice Guidelines as Topic

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