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Since COVID, doctors ‘less likely’ to resuscitate critical patients – UK study

COVID-19 may have changed doctors’ decision-making regarding end of life, making them more willing not to resuscitate very sick or frail patients and raising the threshold for referral to intensive care, show results of research published in the Journal of Medical Ethics.

However, it has not changed their views on euthanasia and doctor-assisted dying, with about a third of respondents still strongly opposed to these policies, the survey responses reveal.

The pandemic transformed many aspects of clinical medicine, including end-of-life care, prompted by millions more patients than usual requiring it around the world, say the researchers.

The Guardian reports that the survey sought to find out if COVID has significantly changed how doctors make end-of-life decisions, specifically in respect of do not attempt cardio-pulmonary resuscitation (DNACPR) notices and treatment escalation to intensive care. Researchers also wanted to know if the pandemic had changed doctors’ views on euthanasia and doctor-assisted suicide.

The survey was open to doctors of all grades and specialties in the UK between May and August 2021. In all, 231 responded.

In respect of DNACPR, the decision not to attempt to restart a patient’s heart when it or breathing stops, more than half were more willing to do this than previously.

When the responses were weighted to represent the different medical grades in the NHS national workforce, the results were: “significantly less” 0%; “somewhat less” 2%; “same or unsure” 35%; “somewhat more” 41.5%; “significantly more” 13%; and “not applicable” 8.5%.

Asked about the contributory factors, the most frequently cited were: “likely futility of CPR” (88% pre-pandemic, 91% now): coexisting conditions (89% both pre-pandemic and now): and patient wishes (83.5% pre-pandemic, 80.5% now). Advance care plans and “quality of life” after resuscitation were also commonly cited.

The number of respondents who said “patient age” was a major factor informing their decision grew from 50.5% pre-pandemic to about 60%. And the proportion who cited a patient’s frailty rose by 15 percentage points from 58% pre-pandemic to 73%.
The biggest change, however, was in those citing “resource limitation”, which increased by 20 percentage points, from 2.5% to 22.5%.

When asked whether the thresholds for escalating patients to intensive care or providing palliative care had changed, the largest proportion said the “same or unsure”: 46% (weighted) for referral; 64.5% (weighted) for palliative care.

But a substantial minority said that they now had a higher threshold for referral to intensive care (22.5% weighted) and a lower threshold for palliation (18.5% weighted).

“What is yet to be determined is whether these changes will now stay the same indefinitely, revert to pre-pandemic practices, or evolve even further,” the researchers concluded.

When it came to euthanasia and doctor-assisted suicide, the responses showed the pandemic has led to marginal, but not statistically significant, changes of opinion.

Study details

How is COVID-19 changing the ways doctors make end-of-life decisions?

Benjamin Kah Wai Chang, Pia Matthews

Published in Journal of Medical Ethics in July 2022

Abstract
Background
This research explores how the COVID-19 pandemic has changed the ways doctors make end-of-life decisions, particularly around Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR), treatment escalation and doctors’ views on the legalisation of euthanasia and physician-assisted suicide.

Methods
The research was conducted between May and August 2021, during which COVID-19 hospital cases were relatively low and pressures on NHS resources were near normal levels. Data were collected via online survey sent to doctors of all levels and specialties, who have worked in the NHS during the pandemic.

Results
231 participants completed the survey. The research found that over half of participants reported making more patients DNACPR than prepandemic, and this was due, at least in part, to an increased focus on factors including patient age, Clinical Frailty Scores and resource limitations. In addition, a sizeable minority of participants reported that they now had a higher threshold for escalating patients to ITU and a lower threshold for palliating patients, with many attributing these changes to formative experiences gained during the pandemic. Finally, our study found that there has not been a statistically significant change in the views of clinicians on the legalisation of euthanasia or physician-assisted suicide since the start of the pandemic.

Conclusion
The COVID-19 pandemic appears to have altered several aspects of end-of-life decision making, and many of these changes have remained even as COVID-19 hospital cases have declined.

 

Journal of Medical Ethics article – How is COVID-19 changing the ways doctors make end-of-life decisions? (Open access)

 

The Guardian article – UK doctors ‘less likely’ to resuscitate the most seriously ill patients since Covid (Open access)

 

See more from MedicalBrief archives:

 

Murder, euthanasia or a doctor’s discretion in pain management?

 

Regulator’s disturbing findings on blanket ‘Do Not Resuscitate’ orders

 

NHS wanted Do Not Resuscitate orders on all care home residents

 

Lack of clarity over DNR

 

 

 

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