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Knowledge and Attitude of ER and ICU Physicians towards DNR in a Tertiary Care Center in Saudi Arabia: A Survey Study

Alaa Gouda1, Norah Alrasheed, Alaa Ali, Ahmad Allaf, Najd Almudaiheem, Youssuf Ali, Ahmad Alghabban and Sami Alsalolami

Introduction: Only a few studies from Arab Muslim countries address DNR practice. Our institute has a clear DNR policy. The knowledge of the existing policy and the attitude towards DNR of emergency room (ER) and intensive care unit (ICU) physicians were studied through this survey.
Objective: To identify the knowledge of the participants of the local DNR policy and guidelines and to summarize the possible barriers of addressing DNR including religious background.
Method: A questionnaire has been distributed to ER and ICU physicians. The answers to the questions were tabulated and analyzed using frequencies and percentage.
Results: Total of 112 physicians with majority (97.3%) are from a Muslim religion. Among the participants 108 (96.4%) were aware about the existence of DNR policy in our institute. 107 (95.5%) stated that DNR is not against Islamic rules. Only (13.4%) of the physicians have advance directives and (90.2%) answered they will request to be placed as DNR if they have terminal illness. Lack of patients and families understanding (51.8%) and inadequate training (35.7%) were the 2 most important barriers for effective DNR discussion. Patients and Families level of education (58.0%) and cultural factors (52.7%) were the main obstacles in initiating a DNR order. Only (1.8%) of the participants stated that DNR is against their religious belief.
Conclusions: There is a lack of knowledge about DNR policy which make the optimization of DNR process difficult. Most physicians wish DNR for themselves and their patients at end of life but only a few of them have advance directives. The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the culture of patients. Most of the Muslim physicians believe that DNR is not against Islamic rules. We suggest that the DNR concept should be part of any training program.