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How do doctors discuss do-not-resuscitate orders?

The Western Journal of Medicine

|August 1, 1985

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Physicians show significant variation in discussing do not resuscitate (DNR) orders, with inconsistent approaches to patient preferences and cardiopulmonary resuscitation (CPR) information. This highlights a need for standardized communication strategies in end-of-life care discussions.

Area of Science:

Medical Ethics
Clinical Communication
Patient-Centered Care

Background:

Patient preferences are crucial for do not resuscitate (DNR) order decisions.
Physician communication practices regarding DNR orders are not well understood.

Purpose of the Study:

To investigate how physicians discuss DNR orders with patients.
To identify variations in physician communication during simulated DNR discussions.

Main Methods:

Fifteen physicians participated in simulated discussions about DNR orders with a patient.
Analysis focused on how physicians elicited patient preferences, described cardiopulmonary resuscitation (CPR), and made recommendations.

Main Results:

Significant variation observed in physicians' explicit requests for patient preferences.

Keywords:

Death and Euthanasia Empirical Approach University of California, San Francisco

Related Experiment Videos

Inconsistent descriptions of CPR and its outcomes were noted.

Physicians' recommendations and the amount of CPR information provided lacked a discernible pattern.

Conclusions:

Physician communication regarding DNR orders is highly variable.
Conflicting rationales were given for individualizing patient discussions.
Increased awareness of communication variability may prompt physicians to reflect on their DNR discussion practices.