Discussion of the do-not-resuscitate (DNR) orders with the family caregivers of cancer patients: An example from a major cancer center in Saudi Arabia

• Published in: Palliative & supportive care 2024-06, Vol.22 (3), p.511-516
• Main Authors: Al-Shahri, Mohammad Z, Sroor, Mahmoud, Ghareeb, Wael Ali Said, Alhassanin, Suzan, Ateya, Heba Aly
• Format: Article
• Language: English
• Subjects: Adult; Aged; Caregivers - psychology; Caregivers - statistics & numerical data; Cross-Sectional Studies; Decision Making; Female; Humans; Male; Middle Aged; Neoplasms - psychology; Resuscitation Orders - psychology; Saudi Arabia; Surveys and Questionnaires
• ISSN: 1478-9515; 1478-9523; 1478-9523
• DOI: 10.1017/S1478951523001876

To explore the views of the family caregivers (FCGs) about the "do-not-resuscitate" (DNR) discussions and decision-making processes that occurred during hospitalization in a Saudi cancer center. In this cross-sectional survey, the FCGs of inpatients with advanced cancer completed a self-administered questionnaire soon after giving the patients a DNR status designation by their oncologists. Eighty-two FCGs participated in the study, with a median age of 36.5 years and male preponderance (70.7%). The FCGs were mostly sons (41.5%), daughters (14%), or brothers (11%) of patients. Only 13.4% of mentally competent patients had the chance to listen to the DNR discussion. The discussion mainly occurred in the ward corridor (48.8%) or another room away from the patients' rooms (35.4%). In 36.6% of cases, the discussion took ≤5 minutes. Half of the FCGs stated that the oncologists' justifications for the DNR decision were unconvincing. The majority (84.2%) of the FCGs felt that the healthcare providers should share the DNR decision-making with patients (1.2%), families (69.5%), or both (13.4%). FCGs ≤ 30 years of age were more supportive of giving patients' families a chance to participate in the DNR decision-making process ( = 0.012). There is considerable room for improving the current practice of DNR discussions and decision-making processes in the studied setting. A readily feasible rectifying measure is to ensure the adequacy of time and privacy when planning for DNR discussions. We expect our findings to draw the attention of stakeholders to a compelling need for reviewing the current policies and processes, aiming to improve the experience of cancer patients and their FCGs.