Code Status Discussions in Muslim ICU Patients: Insights Into Physician-Family Communication

NCT07243041 | Recruiting

• 1 other identifier: 2251305
• Study Type: observational
• Target: 320
• Locations: 1 country
• Sites: 1

Brief Summary

This observational study aims to explore the real-time experiences, perceptions, and challenges faced by intensive care unit (ICU) physicians during goals-of-care discussions-specifically Do Not Attempt Resuscitation (DNAR) and end-of-life decision-making conversations-with families of critically ill patients in a Muslim-majority healthcare setting. The study seeks to identify factors that influence whether a DNAR decision is reached after physician-family discussions, and how physician experience, family dynamics, religious perspectives, and institutional support affect communication outcomes and care transitions. Participants will include ICU physicians (residents, fellows, and consultants) who routinely conduct DNAR discussions as part of clinical care. After each discussion, physicians will complete a brief structured questionnaire about their perceptions of the interaction, family emotions, and decision outcomes. These responses will be anonymously linked to limited, de-identified patient-level data (e.g., diagnosis, ICU course, and outcome) extracted retrospectively from the electronic medical record. No patients or family members will be contacted directly. Data collection will occur prospectively over two years at King Faisal Specialist Hospital \& Research Centre-Jeddah. Findings from this study are expected to provide culturally grounded insights that inform physician training, enhance family-centered communication, and guide policy development for DNAR and end-of-life discussions in Muslim-majority intensive care units.

Conditions

End of Life Care; Muslim; Decision Making ,Shared

Keywords

goals of care; do not attempt resuscitation; ICU; Shared Decision-Making; Family Communication; Muslim Healthcare Context; Cultural Factors; palliative care

Outcome Measures

Primary Outcomes (1)

• Number of Participants with Do Not Attempt Resuscitation (DNAR) Status After Goals-of-Care Discussion

  Final resuscitation status immediately following each goals-of-care discussion, categorized as Do Not Attempt Resuscitation (DNAR, including DNAR with or without limited interventions) versus Full Code. The outcome will be analyzed as a binary variable representing whether DNAR status was established following the discussion.

  After each DNAR discussion

Study Arms (1)

ICU DNAR Discussion Episodes

Adult ICU patients with DNAR discussions during the study period. Observational study; no interventions. Physicians complete post-discussion questionnaires, and limited retrospective EMR data are collected to examine factors influencing DNAR decision outcomes, including final code status

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult ICU patients (≥18 years) for whom a code status discussion regarding Do Not Attempt Resuscitation (DNAR) occurs during the study period (November 2025 to October 2027). Participating ICU physicians will complete a structured post-discussion questionnaire. Limited retrospective patient data will be extracted from the electronic medical record to characterize clinical context, ICU course, and outcomes. The study includes all eligible ICU physicians involved in these discussions who consent to participate.

You may qualify if:

• ICU physicians (residents, fellows, assistant consultants, or consultants) involved in direct patient care
• ICU physicians who conduct code status or Do Not Attempt Resuscitation (DNAR) discussions with patients' families during ICU admission
• Willingness of ICU physicians to participate voluntarily by completing a post-goals-of-care discussion questionnaire
• Adult patients (≥18 years) admitted to the ICU during the study period for whom a code status discussion occurred

You may not qualify if:

• ICU physicians who decline participation
• Code status discussions involving patients younger than 18 years of age
• Discussions in which the physician was not directly involved

Sponsors & Collaborators

• King Faisal Specialist Hospital & Research Center: lead

Study Sites (1)

King Faisal Specialist Hospital & Research Center

Jeddah, Mecca Region, 21499, Saudi Arabia

RECRUITING

Related Publications (16)

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• Alao DO, Abraham S, Dababneh E, Roby R, Farid M, Mohammed N, Rojas-Perilla N, Cevik AA. Do-not-attempt-resuscitation decision making: physicians' recommendations differ from the GO-FAR score predictions. Int J Emerg Med. 2024 Jul 11;17(1):86. doi: 10.1186/s12245-024-00669-3.

  PMID: 38992598 BACKGROUND

• Padela AI, Zaganjor H. Relationships between Islamic religiosity and attitude toward deceased organ donation among American Muslims: a pilot study. Transplantation. 2014 Jun 27;97(12):1292-9. doi: 10.1097/01.TP.0000441874.43007.81.

  PMID: 24646775 BACKGROUND

• Padela AI, Zaidi D. The Islamic tradition and health inequities: A preliminary conceptual model based on a systematic literature review of Muslim health-care disparities. Avicenna J Med. 2018 Jan-Mar;8(1):1-13. doi: 10.4103/ajm.AJM_134_17.

  PMID: 29404267 BACKGROUND

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  PMID: 24526765 BACKGROUND

• Khalid I, Imran M, Yamani RM, Imran M, Akhtar MA, Khalid TJ. Comparison of Clinical Characteristics and End-of-Life Care Between COVID-19 and Non-COVID-19 Muslim Patients During the 2020 Pandemic. Am J Hosp Palliat Care. 2021 Sep;38(9):1159-1164. doi: 10.1177/10499091211018657. Epub 2021 May 27.

  PMID: 34039050 BACKGROUND

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  PMID: 15448786 BACKGROUND

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  PMID: 11467099 BACKGROUND

• Hamouda MA, Emanuel LL, Padela AI. Empathy and Attending to Patient Religion/Spirituality: Findings from a National Survey of Muslim Physicians. J Health Care Chaplain. 2021 Apr-Jun;27(2):84-104. doi: 10.1080/08854726.2019.1618063. Epub 2019 Jun 10.

  PMID: 31179903 BACKGROUND

Study Officials

• Imran Khalid

  King Faisal Specialist Hospital & Research Center

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Khalid, MD

CONTACT

+966126677777; ikhalid97@kfshrc.edu.sa

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Consultant

Study Record Dates

• First Submitted: November 17, 2025
• First Posted: November 21, 2025
• Study Start: November 1, 2025
• Primary Completion (Estimated): October 31, 2027
• Study Completion (Estimated): October 31, 2027
• Last Updated: December 19, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

SA (1)