Clinician perspectives regarding the do-not-resuscitate order

Area of Science:

• Pediatric critical care medicine
• Medical ethics
• Advance care planning

Background:

• Data on the frequency and timing of pediatric do-not-resuscitate (DNR) orders are available.
• Clinician attitudes and behaviors regarding pediatric DNR orders are not well understood.

Purpose of the Study:

• To identify clinician attitudes regarding the meaning, implication, and timing of the DNR order for pediatric patients.

Main Methods:

• Survey of physicians and nurses in settings where advance care planning is common.
• Assessed attitudes and behaviors concerning DNR orders in pediatric patients.

Main Results:

• 266 clinicians (107 physicians, 159 nurses) responded.
• Significant variability in DNR order interpretation; most (66.9%) view it as limited to cardiopulmonary arrest.
• Over 85% believe DNR orders imply broader care changes (e.g., comfort measures), not just resuscitation limitations.
• Most clinicians feel resuscitation status discussions occur later than ideal.

Conclusions:

• Clinicians interpret DNR orders as broader treatment directives, not solely for cardiopulmonary arrest events.
• There is a consensus that DNR discussions should occur earlier in the pediatric illness trajectory.
• Interventions to enhance clinician skills in advance care discussions and improve order clarity are needed for better pediatric serious illness care.