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Practical guidelines for do-not-resuscitate orders
1Wayne State University School of Medicine, Detroit, MI.
American Family Physician
|November 1, 1994
Summary
Discussions about do-not-resuscitate (DNR) orders often occur too late. Early physician-patient conversations about DNR orders and resuscitation outcomes are crucial for informed decision-making.
Area of Science:
- Medical Ethics
- Patient Care
- Clinical Decision-Making
Background:
- Do-not-resuscitate (DNR) orders are common but often discussed late in patient care.
- Most patients desire physician discussions about resuscitation but rarely have them.
- Legal precedent supports the use of DNR orders, though state laws vary.
Purpose of the Study:
- To highlight the importance of timely discussions regarding do-not-resuscitate orders.
- To inform patients and surrogate decision-makers about resuscitation outcomes.
- To provide guidance on managing conflicts related to DNR decisions.
Main Methods:
- Review of current practices and legal standing of do-not-resuscitate orders.
- Analysis of patient preferences for discussing resuscitation.
- Examination of prognostic data for resuscitation outcomes.
- Discussion of conflict resolution strategies.
Main Results:
- Only 10% of patients have discussed resuscitation with their physicians.
- Initial resuscitation survival is 50%, 24-hour survival is 33%, and hospital discharge survival is 12.5%.
- Conditions like metastatic cancer and sepsis are linked to poor resuscitation outcomes.
Conclusions:
- Physicians should proactively discuss do-not-resuscitate orders and prognosis with patients.
- Facilitated family meetings and ethics consultations can resolve conflicts.
- Legal action should be a last resort in do-not-resuscitate order disputes.