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Related Experiment Videos

Impediments to writing do-not-resuscitate orders.

A H Eliasson1, J M Parker, A F Shorr

  • 1Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.

Archives of Internal Medicine
|October 20, 1999
PubMed
Summary
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Physicians often miss opportunities to implement do-not-resuscitate (DNR) orders due to a lack of physician-patient relationship depth. This study explores reasons why attending physicians do not write DNR orders for high-risk patients.

Area of Science:

  • Medical Ethics
  • Clinical Practice
  • Patient Care

Background:

  • Physicians often lack awareness of patient end-of-life care preferences.
  • Missed opportunities to implement do-not-resuscitate (DNR) orders are common.
  • This gap impacts patient care during critical illness.

Purpose of the Study:

  • To identify reasons why attending physicians do not write DNR orders for patients with increased mortality risk.
  • To understand barriers to end-of-life care discussions and DNR order implementation.

Main Methods:

  • Retrospective review of 613 inpatient records over 4 months.
  • Panel identified indicated DNR orders for patients with high mortality risk.
  • Attending physicians discussed reasons for absent DNR orders.
Keywords:
Death and EuthanasiaEmpirical ApproachWalter Reed Army Medical Center (Washington, DC)

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Main Results:

  • DNR orders were indicated for 149 patients (24%), but absent in 88 (59%).
  • Physicians cited patient not in imminent danger (56%) and need for primary physician discussion (49%) as reasons.
  • Lack of appropriate discussion opportunities (43%) and patient/family refusal (12%) were also noted.

Conclusions:

  • The primary impediment to writing DNR orders is the limited extent and depth of the physician-patient relationship.
  • Improving communication and understanding patient wishes is crucial for end-of-life care planning.