Comparing attitudes of the public and medical staff towards witnessed resuscitation in an Asian population

Summary

Aim

To compare the attitudes of the public attending at a local Emergency Department and the medical staff towards witnessed resuscitation.

Methods

Over a 2-week period in April 2006, we conducted an interview survey on the relatives of patients attending at the Emergency Department of Singapore General Hospital (SGH) via a convenience sampling. We approached 156 people with a response rate of 93.5%. We compared the results with a similar study conducted on the medical staff in the Emergency Department in the same hospital.

Results

Should relatives be present during resuscitation? We found that 73.1% of the public supported witnessed resuscitation compared to only 10.6% of the medical staff (P < 0.001). The most frequently deemed advantage for witnessed resuscitation cited by both groups was that relatives would then have assurance that everything possible had been done for the patient. While 68.8% of the public felt that being allowed into the resuscitation area would help in their grieving processes, only 35.6% of the medical staff shared the same point of view (P < 0.001). Medical staff were less likely to agree that witnessed resuscitation would strengthen the bonds between themselves and the public (P < 0.001). Medical staff were however, more inclined towards the opinion that relatives would have a traumatic experience in witnessing resuscitation of their loved ones (P < 0.001) and that the presence of relatives would cause stress to the medical staff performing resuscitation (P < 0.001).

Conclusion

Locally, we find a discrepancy between healthcare workers and the public towards the concept of witnessed resuscitation. More research is needed on the attitudes of the Asian public and medical staff.

Introduction

The process of actively attempting to revive a patient in cardiac arrest in the presence of family members is known as relative witnessed resuscitation.1, 2 A programme was first described in Foote Hospital, Michigan, USA in 1987, to offer family members the option of being present during resuscitative efforts.³ This has sparked off some controversy among emergency medical staff worldwide.1, 4 While this concept is slowly gaining popularity in Western countries, it is practically unheard of in their Asian counterparts. Perhaps, this can be attributed to the more conservative Asian values towards death and resuscitation.5, 6, 7

Several studies have shown that given a choice, most relatives of patients in the USA and the United Kingdom would choose to be present during resuscitation.3, 8, 9, 10 These advocates of witnessed resuscitation claim that it helps in the grieving process of the relatives.³ Indeed, a prospective randomised controlled trial found a trend towards lower levels of anxiety, depression and grief after witnessed resuscitation.¹¹ However, is this true also of an Asian population who may have a different cultural background?

Healthcare workers, even in Asia, on the other hand, were more likely to be against the idea of witnessed resuscitation.⁷ Family presence was considered a hindrance in resuscitative efforts and thought to affect performance by causing additional stress to medical staff.12, 13 Medico-legal issues were also a major concern.14, 15, 16

Our study aims to compare the attitudes of the public and the medical staff towards witnessed resuscitation in a local hospital setting. Singapore is a multi-cultural country in Southeast Asia with a population of 4.4 million. It is Chinese dominated, with indigenous Malays and Indians making up the other two big racial groups. Medical staff attitudes were assessed previously in a similar study conducted in the same hospital (Phase 1).⁷ Based on these results, it is hoped that current practices will be reviewed.