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Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life

Overview of attention for article published in JAMA Internal Medicine, April 2015
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (98th percentile)
  • Good Attention Score compared to outputs of the same age and source (72nd percentile)

Mentioned by

blogs
3 blogs
policy
1 policy source
twitter
117 tweeters
facebook
5 Facebook pages
googleplus
1 Google+ user

Citations

dimensions_citation
55 Dimensions

Readers on

mendeley
93 Mendeley
Title
Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life
Published in
JAMA Internal Medicine, April 2015
DOI 10.1001/jamainternmed.2015.0295
Pubmed ID
Authors

Elizabeth Dzeng, Alessandra Colaianni, Martin Roland, Geetanjali Chander, Thomas J. Smith, Michael P. Kelly, Stephen Barclay, David Levine, Dzeng, Elizabeth, Colaianni, Alessandra, Roland, Martin, Chander, Geetanjali, Smith, Thomas J, Kelly, Michael P, Barclay, Stephen, Levine, David

Abstract

Controversy exists regarding whether the decision to pursue a do-not-resuscitate (DNR) order should be grounded in an ethic of patient autonomy or in the obligation to act in the patient's best interest (beneficence). To explore how physicians' approaches to DNR decision making at the end of life are shaped by institutional cultures and policies surrounding patient autonomy. We performed semistructured in-depth qualitative interviews of 58 internal medicine physicians from 4 academic medical centers (3 in the United States and 1 in the United Kingdom) by years of experience and medical subspecialty from March 7, 2013, through January 8, 2014. Hospitals were selected based on expected differences in hospital culture and variations in hospital policies regarding prioritization of autonomy vs best interest. This study identified the key influences of institutional culture and policies on physicians' attitudes toward patient autonomy in DNR decision making at the end of life. A hospital's prioritization of autonomy vs best interest as reflected in institutional culture and policy appeared to influence the way that physician trainees conceptualized patient autonomy. This finding may have influenced the degree of choice and recommendations physician trainees were willing to offer regarding DNR decision making. Trainees at hospitals where policies and culture prioritized autonomy-focused approaches appeared to have an unreflective deference to autonomy and felt compelled to offer the choice of resuscitation neutrally in all situations regardless of whether they believed resuscitation to be clinically appropriate. In contrast, trainees at hospitals where policies and culture prioritized best-interest-focused approaches appeared to be more comfortable recommending against resuscitation in situations where survival was unlikely. Experienced physicians at all sites similarly did not exclusively allow their actions to be defined by policies and institutional culture and were willing to make recommendations against resuscitation if they believed it would be futile. Institutional cultures and policies might influence how physician trainees develop their professional attitudes toward autonomy and their willingness to make recommendations regarding the decision to implement a DNR order. A singular focus on autonomy might inadvertently undermine patient care by depriving patients and surrogates of the professional guidance needed to make critical end of life decisions.

Twitter Demographics

The data shown below were collected from the profiles of 117 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 93 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 1%
Japan 1 1%
Unknown 91 98%

Demographic breakdown

Readers by professional status Count As %
Researcher 21 23%
Unspecified 14 15%
Other 11 12%
Professor 8 9%
Student > Ph. D. Student 8 9%
Other 31 33%
Readers by discipline Count As %
Medicine and Dentistry 51 55%
Unspecified 14 15%
Social Sciences 10 11%
Nursing and Health Professions 9 10%
Philosophy 3 3%
Other 6 6%

Attention Score in Context

This research output has an Altmetric Attention Score of 93. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 August 2017.
All research outputs
#177,031
of 13,614,866 outputs
Outputs from JAMA Internal Medicine
#1,080
of 3,677 outputs
Outputs of similar age
#3,924
of 223,565 outputs
Outputs of similar age from JAMA Internal Medicine
#48
of 172 outputs
Altmetric has tracked 13,614,866 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,677 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 131.3. This one has gotten more attention than average, scoring higher than 70% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 223,565 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 98% of its contemporaries.
We're also able to compare this research output to 172 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 72% of its contemporaries.