Care of terminally ill patients: an opinion survey among healthcare providers in the Middle East

Introduction

There is no formal guideline on end of life care issues in the Middle East. We hypothesize that decisions are influenced by personal belief, culture and background training. The purpose of the present study was to compare the opinion of healthcare providers on the care of terminally ill patients.

Methods

An anonymous questionnaire was sent by email to members of the Pan Arab Society of Critical Care with a grace period of 6 months.

Results

The response rate was 46.2%. The findings were as follows: males 91.8%, Muslims 86%, physicians 96%, consultants 70.9%, and aged between 40–50 years 47.7%. Most of the responders had a Middle Eastern training background (33.8%), followed by North American (29.2%) and European (17.6%). There is no formal Do Not Resuscitate (DNR) policy in 62.2% of the participants' institutions. Religion played a major role for 59.3% responders in making the DNR decision. DNR was equivalent to comfort care in 39.5%. In a futile case scenario, Do Not Escalate Therapy was the preferred response (54.7%). The likelihood of a patient once labeled DNR being clinically neglected was a concern among 46.5%. The importance of comfort during dying was a priority for 45.3%, while religious concerns were important in 52.3%. Admission of DNR patients to the ICU was acceptable for 47.7%, and to continue feeding DNR patients for 94%. For 60.5% the best time to discuss end of life issues was prior to the patient getting severely ill. Almost one-half of the responders (46.5%) wanted physicians to have the ultimate authority in the DNR decision. There was no significant effect of place of training and seniority on the management plan, neglect of the patient, right to override the right of the family, the best defining conditions for the patient's death or abuse of the code. Nevertheless, the place of training had a significant effect on the meaning of the code (P < 0.08).

Conclusion

Despite a different training background, the majority of members of the Pan Arab Critical Care Society have a general agreement on care of terminally ill patients. Further studies are needed to form a consensus and formalize a DNR policy for the region.