UK doctors ‘less likely’ to resuscitate the most seriously ill patients since Covid
Doctors are less likely to resuscitate the most seriously ill patients in the wake of the pandemic, a survey suggests.
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, according to the results of the research published in the Journal of Medical Ethics.
However, the pandemic 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.
Related: Third of UK hospital Covid patients had ‘do not resuscitate’ order in first wave
The Covid-19 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 survey sought to find out if it 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: 15 from foundation year 1 junior doctors (6.5%); 146 from senior junior doctors (SHOs) (63%); 42 from hospital specialty trainees or equivalent (18%); 24 from consultants or GPs (10.5%); and 4 others (2%).
In respect of DNACPR, the decision not to attempt to restart a patient’s heart when it or breathing stops, more than half the respondents were more willing to do this than they had been previously.
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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%.
Related: We doctors must learn from what went wrong with ‘do not resuscitate’ orders | Rachel Clarke
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 back 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.