Attitudes towards do-not-resuscitate decisions: differences among health professionals in a Portuguese hospital

Objectives: Implementation of an in-hospital cardiopulmonary resuscitation (CPR) program stresses the need to discuss do-not-resuscitate (DNR) orders, as CPR may not be desirable in some terminally ill patients. Ethical, soci al, educational, and professional issues may influence these decisions. Thi s study was designed to evaluate attitudes among four categories of healthc are professionals. Design and setting: Survey in a tertiary hospital in Portugal. Methods: An anonymous self-completed questionnaire was distributed to 825 s taff members, 527 of whom responded (20 % physicians, 44 % nurses, 20 % hea lth technicians, 16 % healthcare domestic staff). Responses were compared b etween the various health professional groups. Results: The level of medical/health training was positively related to the frequency of DNR decisions (physicians and nurses could foresee more circu mstances warranting DNR decisions than technical/administrator or domestic staff) and negatively related to the willingness to include the patient's f amily in the DNR decision (physicians and nurses saw less need for the fami ly's participation than technical/administrator or domestic staff). Signifi cant differences were also found between professional groups regarding the physician's responsibility and the nurses' participation in DNR decisions. There was no difference between the professional groups regarding the need to note the DNR decision in clinical charts. Conclusion: Health professionals differ in their attitudes concerning DNR d ecisions. In particular, the level of medical/health training and/or degree of involvement with the patient's daily care may play an important role in DNR decisions.