Dying cancer patients talk about physician and patient roles in DNR decision making.
BACKGROUND
Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives.


OBJECTIVE
Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision.


METHODS
Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital.


RESULTS
Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers.


CONCLUSIONS
When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making.
Eliott
Jaklin A
JA
School of Psychology, The University of Adelaide, Adelaide, SA, Australia. jaklin.eliott@cancer.org.au
Olver
Ian
I
D000328:Adult; D000368:Aged; D001293:Attitude to Death; D001315:Australia; D016887:Cardiopulmonary Resuscitation / Q000523:psychology; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care; D028701:Patient Rights; D026684:Personal Autonomy; D010819:Physician's Role; D010817:Physician-Patient Relations; D016414:Resuscitation Orders / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology*; D028761:Withholding Treatment