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Perspectives on the DNR decision process: A survey of nurses and physicians in hematology and oncology
Open accessAbstract
INTRODUCTION: In cancer care, do-not-resuscitate (DNR) decisions are made frequently; i.e., decisions not to start the heart in the event of a cardiac arrest. A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians, e.g. concerning patient involvement and information. DNR decisions have also been reported to be unclear and documentation inconsistent. OBJECTIVE: The aim was to investigate how important and how likely to happen nurses and physicians considered various aspects of the DNR decision process, regarding participation, information and documentation, as well as which attributes they found most important in relation to DNR decisions. METHODS: A descriptive correlational study using a web survey was conducted, including 132 nurses and 84 physicians working in hematology and oncology. RESULTS: Almost half of the respondents reported it not likely that the patient would be involved in the decision on DNR, and 21% found it unimportant to inform patients of the DNR decision. Further, 57% reported that providing information to the patient was important, but only 21% stated that this was likely to happen. There were differences between nurses and physicians, especially regarding participation by and information to patients and relatives. The attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values, but a difference was found, as nurses chose patient autonomy as the most important value, while physicians rated non-maleficence as the most important value in relation to DNR decisions. CONCLUSION: Nurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so that they can develop a deeper understanding of the decisions, especially in cases where they disagree. They should also be aware that what they think is important is not always likely to happen. The organization needs to support such discussions through providing an environment that allows ethical discussions on regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.
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“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 [46]
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“57% of practitioners reported that providing information to the patient was important and 21% stated that this was likely to happen.46”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [46]
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“Almost half of the respondents in one study reported that it was not likely that the patient would be involved in the decision on DNACPR46”
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“There were differences between nurses and physicians, regarding participation by and information to patients and those close to the patient.46”
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Metadata
- Authors
- Pettersson, M., Höglund, A. T., & Hedström, M.
- Affiliations
- Uppsala University (SE)
- Corresponding author
- Pettersson, Mona
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-11-21
- Volume
- 13
- Issue
- 11
- Pages
- e0206550
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6248939
- OpenAlex
- W2894666520
- Cited by
- 43
- References
- 39
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 10 · 2022: 3 · 2021: 11 · 2020: 6 · 2019: 1
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- 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 › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- do-not-resuscitate orders, nurses' perceptions, physicians' perspectives, patient and family information, clinical documentation, patient autonomy, non-maleficence, interprofessional differences
- MeSH terms
- Adult, Aged, Attitude of Health Personnel, Decision Making, Documentation, Family, Female, Hematology, Humans, Health Knowledge, Attitudes, Practice, Male, Medical Oncology, Middle Aged, Nurses, Physicians, Professional-Patient Relations, Specialization, Resuscitation Orders, Young Adult, Health Communication
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