title: Experiences and views of specialist registrars in geriatric medicine on 'do not attempt resuscitation' decisions: a sea of uncertainty?
abstract: BACKGROUND
  Recent cultural changes place doctors under increasing pressure to work with their patients to reach decisions about end-of-life care.
  
  
  OBJECTIVE
  To survey the experience, practice and opinions of specialist registrars (SPRs) in geriatric medicine regarding 'do not attempt resuscitation' (DNAR) decisions.
  
  
  METHODS
  Postal questionnaire survey.
  
  
  METHODS
  A questionnaire was mailed to all members registered as trainees (n = 408) with the British Geriatrics Society in November 2003; a reminder was sent nine weeks later. Responses were analysed using both quantitative and qualitative (thematic) approaches.
  
  
  RESULTS
  Response rate was 62% (251/408), of whom 235 were still SpRs. Respondents played a major role in DNAR decision-making in their day-to-day clinical practice. Over a third of respondents did not feel that locally available guidelines were helpful. More than half sometimes disagreed with their consultants' decision, and a fifth were concerned about the possibility of complaints regarding the decisions they made. The majority felt uncomfortable discussing the issue with the patient, and were more likely to discuss the issue with relatives than with patients.
  
  
  CONCLUSIONS
  Further support and training may improve confidence and positive experiences in relation to DNAR decision-making among training-grade doctors in the UK.
authors.affiliation: Department of Medicine for Elderly, Norfolk and Norwich University Hospital, Norwich, UK. pkyawmyint@aol.com
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
authors.forename: S
authors.initials: S
authors.lastname: Miles
authors.forename: D A
authors.initials: DA
authors.lastname: Halliday
authors.forename: L K
authors.initials: LK
authors.lastname: Bowker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003657:Decision Making; D005853:Geriatrics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008511:Medicine; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D016414:Resuscitation Orders; D013038:Specialization; D011795:Surveys and Questionnaires