Doctors' attitudes regarding not for resuscitation orders.

Objectives. The aims of the present study were to investigate doctors' attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders. Methods. A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and openended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations. Results. Doctors thought the presence of an NFR order both should and does alter care delivered by nursing staff, particularly delivery of pain relief, nursing observations and contacting the medical emergency team. Eighty-five per cent of doctors believed they needed somebody else's consent to write an NFR order (seeking of consent is not a requirement in most Australian jurisdictions). Conclusion. There are complex barriers to the writing and implementation of NFR orders, including doctors' knowledge around the need for consent when cardiopulmonary resuscitation is likely to be futile or excessively burdensome. Doctors also believed that NFR orders result in changes to goals-of-care, suggesting a confounding of NFR orders with palliative care. Furthermore, doctors are willing to write NFR orders where there is clear medical indication and the patient is imminently dying, but are otherwise reliant on patients and family to initiate discussion. [ABSTRACT FROM AUTHOR]