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Doctors Are Inconsistent in Estimating Survival after CPR and Are Not Using Such Predictions Consistently in Determining DNACPR Decisions

Glasgow Pleural Disease Unit, Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
Older People’s Medicine, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK
Norwich Medical School, Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
Ageing Clinical and Experimental Research (ACER), Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
Department of Medicine for the Elderly, Aberdeen Royal Infirmary, NHS Grampian AB25 2ZN, UK
Leicester Medical School, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK
Author to whom correspondence should be addressed.
Geriatrics 2019, 4(2), 33;
Received: 20 March 2019 / Revised: 22 April 2019 / Accepted: 26 April 2019 / Published: 3 May 2019
Background: It is unclear whether doctors base their resuscitation decisions solely on their perceived outcome. Through the use of theoretical scenarios, we aimed to examine the ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision-making. Methods: A questionnaire survey was sent to consultants and specialty trainees across two Norfolk (UK) hospitals during December 2013. The survey included demographic questions and six clinical scenarios with varying prognosis. Participants were asked if they would resuscitate the patient or not. Identical scenarios were then shown in a different order and doctors were asked to quantify patients’ estimated chance of survival. Results: A total of 137 individuals (mean age 41 years (SD 7.9%)) responded. The response rate was 69%. Approximately 60% were consultants. We found considerable variation in clinician estimates of median chance of survival. In three out of six of our scenarios, the survival estimated varied from <1% to 95%. There was a statistically significant difference identified in the estimated median survival between those clinicians who would or would not resuscitate in four of the six scenarios presented. Conclusion: This study has highlighted the wide variation between clinicians in their estimates of likely survival and little concordance between clinicians over their resuscitation decisions. The diversity in clinician decision-making should be explored further. View Full-Text
Keywords: DNACPR; futility; estimating survival; resuscitation DNACPR; futility; estimating survival; resuscitation
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Kidd, A.C.; Honney, K.; Bowker, L.K.; Clark, A.B.; Myint, P.K.; Holland, R. Doctors Are Inconsistent in Estimating Survival after CPR and Are Not Using Such Predictions Consistently in Determining DNACPR Decisions. Geriatrics 2019, 4, 33.

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