Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt.
BACKGROUND
The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated.


OBJECTIVE
The purpose of this study was to determine the impact of different patient characteristics on the following outcomes: (1) patients' wishes for or against CPR, (2) assessments made by physicians of the indication for CPR, and (3) the probability of discordance between patients' wishes and physicians' assessments.


METHODS
In this survey, 1,128 of 1,408 cancer patients received a questionnaire concerning their wish for CPR. In total, 904 patients responded. A total of 61 treating physicians assessed the medical indication for resuscitation. Different predefined patient characteristics were analyzed using both univariate and multivariate analyses.


RESULTS
Ninety percent of responding patients wished to receive CPR. The physicians found indications supporting CPR in 89 % of patients. Age ≥70 years, increasing line of treatment, poor prognosis, living alone, and poor self-rated physical and mental health enhanced both patients' wishes and physicians' assessments to withhold CPR. However, only age ≥70 years, poor prognosis, and poor self-rated physical health significantly predicted rejection of CPR in multivariate analyses. The likelihood of discordance between patients and physicians was significantly higher when the patient was ≥70 years and when the expected 5-year survival was <25 %.


CONCLUSIONS
Factors associated with the imminence of dying influenced both patients and physicians to refrain from CPR, and perhaps more surprisingly, the probability of discordance between patients and physicians increased.
Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark, lenanielsen80@hotmail.com.
Lena
L
Saltbaek
Hanne M
HM
Michelsen
Knud M
KM
Nelausen
Rikke
R
Gut
Dorte L
DL
Nielsen
D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000941:ethics / Q000523:psychology*; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011379:Prognosis; D016414:Resuscitation Orders / Q000941:ethics* / Q000523:psychology*; D057566:Self Report; D011795:Surveys and Questionnaires