title: Spiritual background and its association with the medical decision of, DNR at terminal life stages.
abstract: In recent years personal and clinical dilemmas relating to terminally ill patient-care medical, decisions have increased significantly. Although understanding the patient's medical, nursing and, social background is important, a comprehensive appraisal essential for treating the "whole patient" is, incomplete without a spirituality assessment. Religious beliefs and practices affect medical and health, care decisions and require recognition as a dynamic in coping with suffering, loss, life, and death. Taking a spiritual background obtains information that is meaningful to the patient's life and may, influence the medical decision-making relating to health. A study was undertaken to determine, whether assessing the spiritual background influences medical decisions-making regarding the use of, DNR. The target population was 46 family-member caregivers of non-communicative patients in the Herzog, Hospital Skilled Nursing ward located in Jerusalem. The spiritual assessment questionnaire was the, acronym FICA (faith, importance, community and addressing). Two-thirds of the families were opposed to a determination utilizing do not resuscitate (DNR). Multivariate, analysis of the findings found that only religious affiliation was statistically significant (p=0.003). The doctors recommend DNR in 67% of the cases while the family caregiver accepted this decision in, only 33% of the cases. The hypothesis was verified. People who are perceived as being religious or as being greatly influenced, by faith/spirituality opposed the recommendation implementing DNR. Obtaining a spiritual background assists the physician to understand the patient or family spirituality, facilitates sensitivity to value frameworks and preferences in making medical and health-related, decisions.
authors.affiliation: Skilled Geriatric Nursing Department, Herzog Hospital, Affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel. Electronic address: jaul@zahav.net.il.
authors.forename: Efraim
authors.initials: E
authors.lastname: Jaul
authors.forename: Yonit
authors.initials: Y
authors.lastname: Zabari
authors.forename: Jenny
authors.initials: J
authors.lastname: Brodsky
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D001293:Attitude to Death; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D029181:Spirituality; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Do not resuscitate (DNR); End of life issue; Geriatric patients; Medical decision-making; Spiritual background