Risk of mistaken DNR orders

A questionnaire study was carried out among attendants at a community cancer center to determine the subjects' preferences and understanding of the meaning of do-not-resuscitate (DNR). Only 34% correctly understood the meaning of DNR, and 66% thought that DNR was administered only to prolong life without realizing that a DNR decision would result in not being resuscitated even if the cause of the sudden death was potentially reversible. We then determined the subjects' preferences if they had developed a treatment complication needing resuscitation and be put on the ventilator machine temporarily. When the subject was not expected to be alive in 6 months, the preference for resuscitation was not related to correct understanding. However, when the chance of cure was 30%, a preference for resuscitation was related to an incorrect understanding of the meaning of DNR. About 70% of respondents who would accept ventilator care had an incorrect understanding of DNR. The adjusted odds for the correct understanding of DNR were less for respondents who preferred resuscitation. The adjusted odds ratio (AOR) was 0.58 (CI: 0.35-0.93) (p=0.02) after adjusting for age and 0.53 (CI: 0.32-0.86) (p=0.01) after adjusting for both age and treatment group. These results suggest that physicians should be open to the possibility that patients may not always understand what DNR means, and they may be placed on DNR by mistake.