Background It has been established that families play a significant role in decision making in Asian societies, particularly those imbued with family centric ideals and Confucian ethics. Yet the implication of familial determination and its anticipated effect upon end of life decision-making, particularly ‘do not resuscitate’ (DNR) orders remain unstudied in this region.
Aims To determine the views of oncology and palliative care doctors and nurses on who should be involved in DNR discussions and the implications and perceptions of such orders.
Methods 146 doctors and nurses in oncology and palliative care working within a tertiary specialist cancer centre in Singapore participated in a questionnaire survey.
Results Majority thought that patients (78.8%) and their next-of-kin (78.1%) should be involved in DNR discussions, but only 24.7% thought as many family members as possible should be involved. On a 5-point Likert scale, 15.1% thought doctors should always ultimately decide on the DNR order, while 22.6% felt that the patient/family should always take on the responsibility. Between patients and their families, 21.2% felt that patients should always be more involved as opposed to just 4.8% who opted for the family always being more involved. 35.6% felt that a DNR should be discussed as early as possible and 10.2% felt it should be discussed when prognosis was a week or less.
Conclusions From the viewpoint of oncology and palliative care healthcare professionals; this paper suggests that local healthcare professionals do subscribe to the patient autonomy albeit with limitations. This for the most part does tally with other studies conducted in Asian contexts that suggest to a greater family involvement than patients in decision-making. This reflects the complexity of decision-making at the end of life and the importance of considering the innumerable psychosocial, cultural, financial and physical factors involved.
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