Wednesday, 1 Feb 2023

Doctors ‘less likely to resuscitate the very sick after pandemic’ – Study

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It was discovered that more than half of doctors were more likely to not resuscitate very sick patients, as well as raise the threshold for intensive care than previously. The impetus to make more patients Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR), prompted by the pressures of the pandemic, persisted even when Covid admissions had returned to relatively low levels.

Study author Dr Benjamin Kah Wai Chang of St Mary’s University Twickenham said: “At the start of the pandemic, the BMA advised clinicians that in the event of
NHS resources becoming unable to meet demand, resource allocation decisions should follow a ­utilitarian ethic.

“However, what is clear from our results is that for a significant proportion of clinicians, resource limitation continued to factor into clinical decision-making – even when pressures on NHS resources returned to near-normal levels.”

He said the survey results also suggested the pandemic helped doctors gain a greater understanding of the risks, burdens and limitations of intensive care and had further educated them in the early recognition of dying patients and value of palliative care.

Dr Chang added: “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.”

However, the survey found the coronavirus crisis has not altered doctors’ views on euthanasia and physician-assisted dying – with around a third of respondents still strongly opposed to such policies.

Dr Chang’s team say the pandemic transformed many aspects of clinical medicine, including end-of-life care, due to thousands more than usual requiring it.

The poll, published online by the Journal of Medical Ethics, was open to doctors of all grades and specialities between May and August last year when hospital admissions for Covid were relatively low.

They had 231 responses: 15 from foundation year one juniors, 146 from senior juniors, 42 from hospital speciality trainees or equivalent, 24 from consultants or GPs and four others.

In respect of DNACPR, more than half were more willing to do it than they had been previously. When responses were weighted to represent different medical grades in the workforce, the results were: significantly less 0 percent, somewhat less 2 percent, same or unsure 35 percent, somewhat more 41.5 percent, significantly more 13 percent and not applicable 8.5 percent.

When asked about contributory factors, the biggest change of vote-share was resource limitation, which increased by 20 percent, from 2.5 pre-pandemic to 22.5 now. Most frequently cited reasons were: likely futility of CPR (91 percent), co-existing conditions (89) and patient wishes (80.5). Patient age as a factor rose from 50.5 percent to around 60 and frailty reasons increased from 58 percent to 73.

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