Presentation (CTI)

OBJECTIVES: Code status discussion is an essential element that significantly influences patient healthcare outcomes. However, it is a real challenge in Arabe countries and culturally oriented communities such as Saudi Arabia due to multiple interacting barriers. Specifically in Saudi Arabia, cultural norms, religious beliefs, and strong family involvement make it much more difficult to initiate a code discussion. Understanding physicians’ perceptions and experiences is critical to improving clinical practice in the end-of-life care setting
METHODS: A sequential mixed-methods study was conducted in a tertiary hospital in Eastern Saudi Arabia. Quantitative data were collected from 80 physicians using a structured questionnaire assessing perceptions and barriers across personal, hospital-related, and family-related domains. Qualitative data were obtained through semi-structured interviews with 10 physicians. Descriptive and inferential statistics were used for quantitative analysis, while thematic analysis was applied to qualitative data. Findings were integrated through triangulation.
RESULTS: Family-related barriers were the most influential factors affecting code status discussions, including prior family experiences (85.1%), religiosity (77.6%), educational level (76.3%), family conflict (72.6%), and denial of illness severity (71.3%). A strong positive correlation was observed between hospital-related and family-related barriers (r=0.628, p<0.001). Physicians who attended training workshops reported greater engagement in code status discussions. Additionally, 85.0% believed palliative care teams facilitate these conversations. Qualitative findings showed family primacy in decision-making, misconceptions regarding code status discussions, physician hesitation, medico-legal concerns, and delayed palliative care involvement. Integrated findings demonstrated that family dynamics, limited training, and system-level constraints contribute to delayed discussions
CONCLUSIONS: : Code status discussions in Saudi Arabia are influenced by interconnected family, physician, and healthcare system factors. Targeted physician training, early palliative care integration, and strategies addressing family-related barriers may improve timely, culturally sensitive, and patient-centered end-of-life decision-making.