Objective: Do not attempt resuscitation (DNAR) orders are becoming more common in children with chronic illnesses. In this study, we compare pediatricians' attitudes about DNAR orders in four venues. Our hypotheses are: 1) venue matters: acceptance of DNAR varies by where the arrest occurs; 2) specialty affiliation matters: acceptance of DNAR varies by pediatric specialization; and 3) the personal influences the professional: pediatricians are more likely to respect and recommend a DNAR if they would choose DNAR for their own child.
Methods: Surveys were sent to 150 pediatricians in each of four sections of the American Academy of Pediatrics: children with disabilities, critical care, emergency medicine, and school health. The survey included four hypothetical vignettes about DNAR in various venues (pediatric intensive care unit, chronic care facility, emergency department, and school) followed by three questions: 1) would you respect the family's choice for DNAR? 2) Would you recommend DNAR to the family? 3) Would you choose DNAR for your own child? Results were analyzed using SPSS software.
Results: Two hundred seventy-nine of 560 eligible surveys (50%) were returned. The majority of respondents were men (62%), white (85%), Christian (61%), and fellowship trained (70%). In three of the scenarios (pediatric intensive care unit, emergency department, and school), most pediatricians were willing to respect (>90%), recommend (>85%), and choose a DNAR for their own child (>75%). For a ventilator-dependent child living in a chronic care facility, respondents were significantly less likely to respect (81%, p < 0.001), recommend (76%, p < 0.001), or want a DNAR for their own child (68%, p < 0.001). In a multivariate analysis, no demographic characteristic consistently correlated with physicians' decisions. However, pediatricians' preferences for DNAR for their own child correlated with recommending DNAR (p < 0.001) for their patients.
Conclusion: DNAR decisions have become well accepted in the pediatric community for both end-of-life and poor quality of life cases.