Is physician specialty related to decision-making for Do-Not-Attempt-Resuscitation among older adults admitted with pneumonia?

Abstract

We examined whether physicians’ specialty, including general medicine (GM), internal medicine (IM), and emergency medicine (EM), is related to code status decision-making by patients admitted to hospital with a diagnosis of pneumonia. A retrospective analysis was conducted on 648 patients aged 65 years and above. Code status was divided into a Do Not Attempt Resuscitation (DNAR) group and a FULL code group from the medical record review. Multivariable logistic regression analysis was performed with code status as the outcome variable, physician's specialty as the main explanatory variable, and patient's and physician’s demographic factors as covariates. There were 386 patients (59.6%) in the DNAR group. Older age, the presence of severe dementia, and low activities of daily living before hospitalization were significant predictors of DNAR orders. Compared to patients seen by EM physicians, those seen by GM were more likely to have DNAR orders (aOR 4.29, 95% Cl: 2.40-7.66). Patients seen by an IM were also more likely to have DNAR orders (aOR 4.11, 95% Cl: 2.16-7.80). Patients were more likely to choose DNAR orders when they were asked about their code status by GM or IM physicians, compared to EM physicians, even after controlling for covariates.