Culture and personal influences on cardiopulmonary resuscitation- results of international survey
Open accessAbstract
Background: The ethical principle of justice demands that resources be distributed equally and based on evidence. Guidelines regarding forgoing of CPR are unavailable and there is large variance in the reported rates of attempted CPR in in-hospital cardiac arrest. The main objective of this work was to study whether local culture and physician preferences may affect spur-of-the-moment decisions in unexpected in-hospital cardiac arrest. Methods: Cross sectional questionnaire survey conducted among a convenience sample of physicians that likely comprise code team members in their country (Indonesia, Israel and Mexico). The questionnaire included details regarding respondent demographics and training, personal value judgments and preferences as well as professional experience regarding CPR and forgoing of resuscitation. Results: Of the 675 questionnaires distributed, 617 (91.4%) were completed and returned. Country of practice and level of knowledge about resuscitation were strongly associated with avoiding CPR performance. Mexican physicians were almost twicemore likely to forgo CPR than their Israeli and Indonesian/Malaysian counterparts [OR1.84 (95% CI 1.03, 3.26), p = 0.038]. Mexican responders also placed greater emphasison personal and patient quality of life (p < 0.001). In multivariate analysis, degree of religiosity was most strongly associated with willingness to forgo CPR; orthodox respondents were more than twice more likely to report having forgone CPR for apatient they do not know than secular and observant respondents, regardless of the country of practice [OR 2.12 (95%CI 1.30, 3.46), p = 0.003]. Conclusions: In unexpected in-hospital cardiac arrest the decision to perform or withhold CPR may be affected by physician knowledge and local culture as well as personal preferences. Physician CPR training should include information regarding predictors of patient outcome at as well as emphasis on differentiating between patient and personal preferences in an emergency.
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Decisions within the healthcare service delivery system are often based on physicians' own opinions.
“The decisions within the healthcare service delivery system are often based on the physicians’ own opinions. 16”
From Artificial Intelligence and Decision-Making in Healthcare: A Thematic Analysis of a Systematic Review of Reviews (2024) · cites this paper as [16]
The Discussion says that, in the countries studied, most physicians rely on their own judgment when making decisions about CPR without advance directives. The Methods specify that the study examined decisions not to begin resuscitation for an unfamiliar patient. This supports the claim for that clinical situation, but not its broader assertion about decisions throughout healthcare service delivery. (LLM, conf=0.86)
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“For example, physicians’ attitudes towards initiating CPR in cardiac arrest can be influenced by their cultural background, (16) and end-of-life decisions can vary significantly across different cultures.”
- Authors
- Ozer, J., Alon, G., Leykin, D., Varon, J., Aharonson-Daniel, L., & Einav, S.
- Affiliations
- Ben-Gurion University of the Negev (IL)
- Tel Aviv University (IL)
- Hebrew University of Jerusalem (IL)
- Corresponding author
- Ozer, Janet
- Venue
- BMC Medical Ethics
- Published
- 2019-12
- Volume
- 20
- Issue
- 1
- Pages
- 102-102
- ISSN
- 1472-6939 (ISSN-L)
- PMC
- PMC6933623
- OpenAlex
- W2997168785
- Cited by
- 19
- References
- 35
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 2 · 2021: 5
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Ethics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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
- cardiopulmonary resuscitation, in-hospital cardiac arrest, physician preferences, religiosity, cultural influence, quality of life, CPR training, cross-national comparison
- MeSH terms
- Clinical Decision-Making, Adult, Aged, Cross-Sectional Studies, Culture, Female, Humans, Indonesia, Israel, Male, Mexico, Middle Aged, Quality of Life, Logistic Models, Cardiopulmonary Resuscitation, Health Care Surveys
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