Misunderstandings of “do not attempt resuscitation” orders among physicians and nurses' perceptions: A questionnaire survey in Japan

Abstract

Aim: This study aimed to clarify the current understanding/misunderstanding regarding the “do not attempt resuscitation (DNAR)” order among physicians and nurses in Japan as well as related factors. Methods: We conducted a questionnaire survey of physicians and nurses working in three Japanese medical institutions. We established “misconception indicators” for DNAR orders and identified related factors using the Mann–Whitney U test, with multiple comparisons using the Dunn test. Differences in each misconception indicator were compared between physicians and nurses using the chi-square test. Results: We obtained survey responses from 134 physicians and 233 nurses. Among them, >70% of physicians and nurses responded that a DNAR order indicated withholding invasive medical care. Moreover, responses suggesting that DNAR prompted palliative care were more common among physicians and nurses working at hospitals without intensive care units or rapid response systems. Additionally, >40% of physicians responded that a DNAR order prompted them to limit the use of medical resources, including the intensive care unit and blood transfusions, with this proportion being higher than that among nurses. Further, physicians with longer clinical experience were more likely to limit the use of medical resources in cases of a DNAR order. Conclusions: Many physicians and nurses misinterpreted a DNAR order as prompting palliative care. To facilitate support toward patient decision-making and correct implementation of DNAR orders, it is important to establish internal guidelines, provide education regarding end-of-life care and medical terminology, and introduce specialized care teams. Geriatr Gerontol Int 2025; 25: 772–780.