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Cited by 12Palliative Care and End-of-Life IssuesEthics and Legal Issues in Pediatric HealthcarePalliative and Oncologic Care

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Pediatricians’ Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review

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Aljethaily, Abdulrahman, Al-Mutairi, Turki, Al-Harbi, Khalid, Al-Khonezan, Saleh, Aljethaily, Abdallah, Al-Homaidhi, Hossam S·2020·Advances in Medical Education and Practice
DOI 10.2147/amep.s228399PMC PMC6954090
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Abstract

Objective: To explore the pediatricians’ attitudes and perceptions toward do-not-resuscitate (DNR) orders in a specific region of the world not fully explored before. Methods: A cross-sectional study was conducted between March 4 and May 30, 2018. Pediatricians from three public hospitals in the city of Riyadh were asked to respond to a questionnaire consisting of 22 questions designed to meet the objectives of our study. Results: A total of 203 pediatricians (51.2% female) completed the questionnaire, both junior pediatricians (JPs) and senior pediatricians (SPs). A majority (58.9% of JPs and 61.4% of SPs) thought patients have the right to demand intensive care, despite their terminal illness. Half the participants in both groups thought that DNR is a physician’s decision. Only 9.3% of JPs and 12.5% of SPs felt comfortable discussing DNR with patients/families. Medical school was also a source of knowledge on DNR issues, mainly for JPs (40.2% of JPs vs 20.8% of SPs, P =0.005). Half the participants felt that DNR is consistent with Islamic beliefs, while 57.9% of JPs vs 41.7% of SPs felt they are legally protected. Hospital policy was clear to 48.6% of JPs vs 66.7% of SPs, while procedure was clear to 35.5% of JPs vs 49% of SPs. Conclusion: Several factors are present that may hinder DNR implementation, such as doubts concerning being legally protected, doubts concerning consistency with Islamic sharia, unclear policies and procedures, and lack of training and orientation on DNR issues. Policies may need to include patients as decision-makers. Keywords: DNR policies, DNR implementation, “shared decision-making” paradigm, attitude toward DNR

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  1. [1]Sehatzadeh S. Cardiopulmonary resuscitation in patients with terminal illness: an evidence-based analysis. Ont Health Technol Assess Ser. 2014; 14: 1– 38. PMC4552960 26339301
  2. [2]Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58: 297– 308. doi: 10.1016/S0300-9572(03)00215-6 12969608 · DOI
  3. [3]Ahmad AS, Mudasser S, Khan MN, Abdoun HN. Outcomes of cardiopulmonary resuscitation and estimation of healthcare costs in potential ‘Do Not Resuscitate’ cases. Sultan Qaboos Univ Med J. 2016; 16: e27– 34. doi: 10.18295/squmj.2016.16.01.006 26909209 PMC4746039 · DOI
  4. [4]Van Delden JJ, Lofmark R, Deliens L, et al. Do-not-resuscitate decisions in six European countries. Crit Care Med. 2006; 34: 1686– 1690. doi: 10.1097/01.CCM.0000218417.51292.A7 16625128 · DOI
  5. [5]Loertscher L, Reed DA, Bannon MP, Mueller PS. Cardiopulmonary resuscitation and do-not-resuscitate orders: a guide for clinicians. Am J Med. 2010; 123: 4– 9. doi: 10.1016/j.amjmed.2009.05.029 20102982 · DOI
  6. [8]Mobeireek A. The do-not-resuscitate order: indications on the current practice in Riyadh. Ann Saudi Med. 1995; 15: 6– 9. doi: 10.5144/0256-4947.1995.6 11656711 · DOI
  7. [9]Amoudi A, Albar M, Bokhari A, Yahya S, Merdad A. Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia. Adv Med Educ Pract. 2016; 7: 165– 170. doi: 10.2147/AMEP.S99441 27051329 PMC4803261 · DOI
  8. [10]Aljohaney A, Bawazir Y. Internal medicine residents’ perspectives and practice about do not resuscitate orders: survey analysis in the western region of Saudi Arabia. Adv Med Educ Pract. 2015; 6: 393– 398. doi: 10.2147/AMEP.S82948 26064076 PMC4451847 · DOI
  9. [11]Gouda A, Al-Jabbary A, Fong L. Compliance with DNR policy in a tertiary care center in Saudi Arabia. Intensive Care Med. 2010; 36: 2149– 2153. doi: 10.1007/s00134-010-1985-3 20838763 · DOI
  10. [12]Al-Ayed T, Rahmo N. Do not resuscitate orders in a Saudi pediatric intensive care unit. Saudi Med J. 2014; 35: 561– 565. 24888654
  11. [13]Al Sheef MA, Al Sharqi MS, Al Sharief LH, Takrouni TY, Mian AM. Awareness of do-not-resuscitate orders in the outpatient setting in Saudi Arabia. Perception and implications. Saudi Med J. 2017; 38: 297– 301. doi: 10.15537/smj.2017.3.18063 28251226 PMC5387907 · DOI
  12. [14]Al-Mobeireek AF. Physicians’ attitudes towards ‘do-not-resuscitate’ orders for the elderly: a survey in Saudi Arabia. Arch Gerontol Geriatr. 2000; 30: 151– 160. doi: 10.1016/S0167-4943(00)00047-9 15374041 · DOI
  13. [15]Goldberg DS. The ethics of DNR orders as to neonatal and pediatric patients: the ethical dimension of communication. Houston J Health Law Policy. 2007; 1: 57– 83.:.
  14. [16]Da Costa DE, Ghazal H, Al-Khusaiby S. Do Not Resuscitate orders and ethical decisions in a neonatal intensive care unit in a Muslim community. Arch Dis Child Fetal Neonatal Ed. 2002; 86: F115– F119. doi: 10.1136/fn.86.2.F115 11882554 PMC1721375 · DOI
  15. [17]McCallum DE, Byrne P, Bruera E. How children die in hospital. J Pain Symptom Manage. 2000; 20(6): 417– 423. doi: 10.1016/S0885-3924(00)00212-8 11131260 · DOI
  16. [18]Jan M, Girvin JP. The communication of neurological bad news to parents. Can J Neurol Sci. 2002; 29: 78– 82. doi: 10.1017/S0317167100001773 11858541 · DOI
  17. [19]Durall A, Zurakowski D, Wolfe J. Barriers to conducting advance care discussions (ACD) for children with life-threatening conditions. Pediatrics. 2012; 129: e975– 82. doi: 10.1542/peds.2011-2695 22392177 · DOI
  18. [20]Ury WA, Berkman CS, Weber CM, Pignotti MG, Leipzig RM. Assessing medical students’ training in end-of-life communication: a survey of interns at one urban teaching hospital. Acad Med. 2003; 78: 530– 537. doi: 10.1097/00001888-200305000-00019 12742792 · DOI
  19. [21]Saeed F, Kousar N, Aleem S, et al. End-of-life care beliefs among Muslim physicians. Am J Hosp Palliat Care. 2015; 32: 388– 392. doi: 10.1177/1049909114522687 24526765 · DOI
  20. [22]Islamic Medical Association of North America (IMANA), & Ethics Committee. Islamic medical ethics: the IMANA perspective. J Islamic Med Assoc North Am. 2005; 37: 33– 42. doi: 10.5915/37-1-5528 · DOI
  21. [23]Vernon DD, Dean JM, Timmons OD, Banner W Jr, Allen-Webb EM. Modes of death in the pediatric intensive care unit: withdrawal and limitation of supportive care. Crit Care Med. 1993; 21: 1798– 1802. doi: 10.1097/00003246-199311000-00035 7802736 · DOI
  22. [24]Sands R, Manning JC, Vyas H, Rashid A. Characteristics of deaths in paediatric intensive care: a 10-year study. Nurs Crit Care. 2009; 14: 235– 240. doi: 10.1111/j.1478-5153.2009.00348.x 19706074 · DOI
  23. [25]Martinot A, Grandbastien B, Leteurtre S, Duhamel A, Leclerc F. Groupe Francophone de Réanimation et d’Urgences Pédiatriques. [No resuscitation orders and withdrawal of therapy in French paediatric intensive care units]. Acta Paediatr. 1998; 87: 769– 773. doi: 10.1111/j.1651-2227.1998.tb01745.x 9722251 · DOI
  24. [26]Siddiqui NU, Ashraf Z, Jurair H, Haque A. Mortality patterns among critically ill children in a pediatric intensive care unit of a developing country. Indian J Crit Care Med. 2015; 19: 147– 150. doi: 10.4103/0972-5229.152756 25810609 PMC4366912 · DOI
  25. [27]Devictor DJ, Nguyen DT. Forgoing life-sustaining treatments in children: a comparison between Northern and Southern European pediatric intensive care units. Pediatr Crit Care Med. 2004; 5: 211– 215. doi: 10.1097/01.PCC.0000123553.22405.E3 15115556 · DOI
  26. [28]Moore P, Kerridge I, Gillis J, Jacobe S, Isaacs D. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature. J Paediatr Child Health. 2008; 44: 404– 408. doi: 10.1111/j.1440-1754.2008.01353.x 18638332 · DOI
  27. [29]Ur Rahman M, Abuhasna S, Abu-Zidan FM. Care of terminally-ill patients: an opinion survey among critical care healthcare providers in the Middle East. Afr Health Sci. 2013; 13: 893– 898. doi: 10.4314/ahs.v13i4.5 24940309 PMC4056474 · DOI · Paper page
  28. [30]Stevenson EK, Mehter HM, Walkey AJ, Wiener RS. Association between Do Not Resuscitate/Do Not Intubate status and resident physician decision-making. a National survey. Ann Am Thorac Soc. 2017; 14: 536– 542. doi: 10.1513/AnnalsATS.201610-798OC 28099054 PMC5427717 · DOI
  29. [31]Beach MC, Morrison RS. The effect of do-not-resuscitate orders on physician decision-making. J Am Geriatr Soc. 2002; 50: 2057– 2061. doi: 10.1046/j.1532-5415.2002.50620.x 12473020 · DOI
  30. [33]Henneman EA, Baird B, Bellamy PE, Faber LL, Oye RK. Effect of do-not-resuscitate orders on the nursing care of critically ill patients. Am J Crit Care. 1994; 3: 467– 472. doi: 10.4037/ajcc1994.3.6.467 7834009 · DOI
  31. [35]Etheridge Z, Gatland E. When and how to discuss “do not resuscitate” decisions with patients. BMJ. 2015; 350: h2640. doi: 10.1136/bmj.h2640 25994629 · DOI
  32. [37]Carlet J, Thijs LG, Antonelli M, et al. Challenges in end-of-life care in the ICU: statement of the 5th international consensus conference in critical care. Brussels, Belgium, April 2003. Réanimation. 2004; 13: 440– 452. doi: 10.1016/j.reaurg.2004.08.001 15098087 · DOI
  33. [38]Truog RD, Campbell ML, Curtis JR, et al. American academy of critical care medicine. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American college of critical care medicine. Crit Care Med. 2008; 36: 953– 963. doi: 10.1097/CCM.0B013E3181659096 18431285 · DOI

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Metadata

Authors
Aljethaily, A., Al-Mutairi, T., Al-Harbi, K., Al-Khonezan, S., Aljethaily, A., & Al-Homaidhi, H. S.
Affiliations
Ministry of Health (SA)
Corresponding author
Al-Homaidhi, Hossam S
Venue
Advances in Medical Education and Practice
Publisher
Informa UK Limited
Published
2020-01
Volume
Volume 11
Pages
1-8
ISSN
1179-7258 (ISSN-L)
DOI
10.2147/amep.s228399
PMC
PMC6954090
OpenAlex
W2996917144
Cited by
12
References
0
Citations by year
2025: 1 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 2
FWCI
1.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Advances in Medical Education and Practice (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
do-not-resuscitate orders, pediatricians' attitudes, physician perceptions, end-of-life decisions, terminal illness, intensive care, Islamic law, legal protection of physicians, shared decision-making, physician training, Saudi Arabia

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CoChat. (2026). Citation check: Pediatricians’ Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review. https://app.cochat.ai/papers/10.2147/amep.s228399
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Aljethaily, A., Al-Mutairi, T., Al-Harbi, K., Al-Khonezan, S., Aljethaily, A., & Al-Homaidhi, H. S. (2020). Pediatricians’ Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review. Advances in Medical Education and Practice. https://doi.org/10.2147/amep.s228399