"Do-not-resuscitate" preferences of the general Swiss population: Results from a national survey

Sebastian Gross; Simon A Amacher; Anton Rochowski; Stefan Reiser; Christoph Becker; Katharina Beck; René Blatter; Christian Emsden; Coralie Nkoulou; Raoul Sutter; Kai Tisljar; Hans Pargger; Stephan Marsch; Sabina Hunziker

doi:10.1016/j.resplu.2023.100383

"Do-not-resuscitate" preferences of the general Swiss population: Results from a national survey

Resusc Plus. 2023 Apr 5:14:100383. doi: 10.1016/j.resplu.2023.100383. eCollection 2023 Jun.

Authors

Sebastian Gross¹, Simon A Amacher^{1

2

3}, Anton Rochowski⁴, Stefan Reiser⁴, Christoph Becker^{1

3}, Katharina Beck¹, René Blatter¹, Christian Emsden^{2

5}, Coralie Nkoulou⁶, Raoul Sutter^{2

7}, Kai Tisljar², Hans Pargger^{2

7}, Stephan Marsch^{2

7}, Sabina Hunziker^{1

7}

Affiliations

¹ Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
² Department of Intensive Care, University Hospital Basel, Basel, Switzerland.
³ Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland.
⁴ Link Marketing Services AG, Lucerne, Switzerland.
⁵ Institute of Nursing Science, University of Basel, Basel, Switzerland.
⁶ Department of Intensive Care, University Hospital Zurich, Zurich, Switzerland.
⁷ Medical Faculty, University of Basel, Basel, Switzerland.

Abstract

Aims: To assess the do-not-resuscitate preferences of the general Swiss population and to identify predictors influencing decision-making.

Methods: A nationwide web-based survey was conducted in Switzerland on a representative sample of the adult population. The primary endpoint was the preference for a "Do Not Resuscitate" order (DNR Code Status) vs. cardiopulmonary resuscitation (CPR Code Status) in a clinical case vignette of an out-of-hospital cardiac arrest. Secondary endpoint were participants' own personal preferences for DNR.

Results: 1138 subjects participated in the web-based survey, 1044 were included in the final analysis. Preference for DNR code status was found in 40.5% (n = 423) in the case vignette and in 20.3% (n = 209) when making a personal decision for themselves. Independent predictors for DNR Code Status for the case vignette were: Personal preferences for their own DNR Code Status (adjusted OR 2.44, 95%CI 1.67 to 3.55; p < 0.001), intubation following respiratory failure (adjusted OR 1.95, 95%CI 1.20 to 3.18; p = 0.007), time-period after which resuscitation should not be attempted (adjusted OR 0.91, 95%CI 0.89 to 0.93); p < 0.001), and estimated chance of survival in case of a cardiac arrest (adjusted OR per decile 0.91, 95%CI 0.84 to 0.99, p = 0.02; which was overestimated by all participants.

Conclusions: Main predictors for a DNR Code Status were personal preferences and the overestimation of good neurological outcome after cardiac arrest. Overestimation of positive outcomes after cardiac arrest seems to influence patient opinion and should thus be addressed during code status discussions.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; End-of-life care; Ethics; Personal preferences; Shared-decision-making.