Interpretations and Views of Hospital Specialists and Residents on the Decision-Making Process, Documentation, and Education of the Do Not Attempt Resuscitation (DNAR) Order

A Do Not Attempt Resuscitation (DNAR) order is one of the most important medical decisions in providing adequate end-of-life care. Physicians in general perceive challenges in decision-making and in interpreting DNAR orders. Our objectives were to explore hospital specialists' and residents’ opinions and perceptions of the DNAR order-making process and training related to DNAR order-making. A link to the web-based multiple-choice questionnaire was sent by e-mail to all physicians working in the special responsibility area of the Tampere University Hospital. The questionnaire covered several issues related to DNAR orders, including their meaning and documentation. Participants responded anonymously. Residents' responses were compared with those of specialists. 219 physicians covering all specialties responded. A total of 155 (71%) were specialists and 64 (29%) were residents. Challenges in DNAR order-making, documentation, and interpretation were more common among residents (60%) than among specialists (34%) (p < 0.001). Training in DNAR order-making was considered adequate by 40% (n=25) of the residents, compared with 61% (n=94) of the specialists (p=0.007). Structured education on DNAR protocols and end-of-life decision-making should be incorporated into all clinical specialty training programs. Integration of artificial intelligence (AI)-based decision-support tools into electronic health record (EHR) systems may further enhance consistency and accuracy in the DNAR process.