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’ end-of-life decision-making, 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 physician-assisted dying, with about a third of respondents still strongly opposed to these policies, survey responses reveal.
The Covid-19 pandemic transformed many aspects of clinical medicine, including end-of-life care, prompted by millions more patients than usual requiring it worldwide, researchers say.
The survey sought to find out whether there has been a significant change in the way doctors make decisions at the end of life, specifically regarding do not attempt cardiopulmonary resuscitation (DNACPR) and escalation of treatment to intensive care. The researchers also wanted to know whether the pandemic had changed doctors’ views on euthanasia and assisted suicide.
The survey was open to doctors of all grades and specialties in the UK between May and August 2021. In total, 231 responded: 15 first-year junior doctors (6.5%); 146 of first-time doctors (SHO) (63%); 42 from hospital specialty students or equivalent (18%); 24 from consultants or general practitioners (10.5%); and 4 more (2%).
When it comes to DNACPR, the decision not to try to restart a patient’s heart when they stop or breathing, more than half of respondents were more willing to do so than before.
When responses were weighted to represent the different medical grades in the national NHS workforce, the results were: ‘significantly less’ 0%; “a little less” 2%; “same or unsure” 35%; “a little more” 41.5%; “significantly more” 13%; and “not applicable” 8.5%.
When asked about the contributing factors, the most cited were: “probable futility of CPR” (88% pre-pandemic, 91% now): coexisting conditions (89% both pre-pandemic and now): and patient wishes ( 83.5% pre-pandemic). -pandemic, 80.5% now). Advanced care plans and “quality of life” after resuscitation were also commonly cited.
The number of respondents who said “the age of the patient” was an important factor informing their decision grew from 50.5% before the pandemic to about 60%. And the proportion citing a patient’s frailty rose by 15 percentage points from 58% before the pandemic to 73%.
The biggest change, however, was in those who cited “limited resources,” which rose 20 percentage points, from 2.5% to 22.5%.
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When asked whether the thresholds for escalating patients to intensive care or providing palliative care had changed, the largest proportion said the same or not sure: 46% (weighted) for referral; 64.5% (weighted) for palliative care.
But a substantial minority said they now had a higher threshold for referral to intensive care (22.5% weighted) and a lower threshold for palliation (18.5% weighted).
“What remains to be determined is whether these changes will now continue indefinitely, return to pre-pandemic practices, or evolve further,” the researchers concluded.
Regarding euthanasia and physician-assisted suicide, responses showed that the pandemic has led to marginal, but not statistically significant, changes in opinion.