P K Myint1, C A Rivas, L K Bowker. 1. School of Medicine, Health Policy and Practice, Chancellors Drive, University of East Anglia, Norwich, NR4 7UY, Norfolk, UK. phyo.k.myint@uea.ac.uk
Abstract
BACKGROUND: To examine the personal experiences of higher specialist trainees in Geriatric Medicine (GM) with regard to cardiopulmonary resuscitation (CPR) and do not attempt resuscitation (DNAR) decision making. SETTING: UK. PARTICIPANTS: Two hundred and thirty-five higher trainee members of the British Geriatrics Society (BGS) at the Specialist Registrar (SpR) level. DESIGN: Postal questionnaire survey. METHODS: We distributed a questionnaire examining the various issues around DNAR decision making among the trainee members of the BGS in November 2003. In one of the questions, we asked the participants, 'Briefly describe your worst or most memorable experience of DNAR'. Responses to this question were analysed by thematic schema and are presented. RESULTS: Overall the response rate was 62% (251/408) after second mailing and 235 of these were at SpR grade. One hundred and ninety-eight participants provided an answer to the above question, providing diverse and often detailed accounts, most of which were negative experiences and which appeared to have had a powerful influence on their ongoing clinical practice. The emerging themes demonstrated areas of conflict between trainees and other doctors as well as patients and relatives. CONCLUSION: SpR grade geriatricians are exposed to extreme and varied experiences of DNAR decision making in the UK. Efforts to improve support and training in this area should embrace the complexity of the subject.
BACKGROUND: To examine the personal experiences of higher specialist trainees in Geriatric Medicine (GM) with regard to cardiopulmonary resuscitation (CPR) and do not attempt resuscitation (DNAR) decision making. SETTING: UK. PARTICIPANTS: Two hundred and thirty-five higher trainee members of the British Geriatrics Society (BGS) at the Specialist Registrar (SpR) level. DESIGN: Postal questionnaire survey. METHODS: We distributed a questionnaire examining the various issues around DNAR decision making among the trainee members of the BGS in November 2003. In one of the questions, we asked the participants, 'Briefly describe your worst or most memorable experience of DNAR'. Responses to this question were analysed by thematic schema and are presented. RESULTS: Overall the response rate was 62% (251/408) after second mailing and 235 of these were at SpR grade. One hundred and ninety-eight participants provided an answer to the above question, providing diverse and often detailed accounts, most of which were negative experiences and which appeared to have had a powerful influence on their ongoing clinical practice. The emerging themes demonstrated areas of conflict between trainees and other doctors as well as patients and relatives. CONCLUSION: SpR grade geriatricians are exposed to extreme and varied experiences of DNAR decision making in the UK. Efforts to improve support and training in this area should embrace the complexity of the subject.