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Roadblocks to do-not-resuscitate orders. A study in policy implementation
B E Paris1, V G Carrion, J S Meditch
1Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY.
Archives of Internal Medicine
|July 26, 1993
Summary
Physicians find discussing do-not-resuscitate (DNR) orders with patients and surrogates challenging. Procedural rules for DNR orders are not major obstacles, suggesting a need for better communication about advance directives.
Area of Science:
- Medical Ethics
- Healthcare Policy
- Patient Rights
Background:
- Cardiopulmonary resuscitation (CPR) is initiated for hospitalized patients without a do-not-resuscitate (DNR) order.
- New York State Law permits DNR orders with patient or surrogate consent, sometimes requiring concurring physician and witness signatures.
- This study investigates physician-identified obstacles in implementing DNR orders.
Purpose of the Study:
- To identify physician-encountered obstacles when implementing do-not-resuscitate (DNR) orders for hospitalized patients.
- To assess the impact of communication and procedural regulations on DNR order implementation.
Main Methods:
- A questionnaire was administered to 60 house staff officers and 45 attending physicians at two New York City medical centers.
- Respondents rated the prevalence of 18 potential problems in obtaining a DNR order using a Likert scale.
Main Results:
- Attending physicians' failure to discuss DNR issues with patients and surrogate decision-making scenarios are significant obstacles.
- Procedural aspects, such as paperwork and witnessed signatures, were not identified as major impediments to DNR order implementation.
Conclusions:
- Improved communication between physicians, patients, and surrogates regarding advance directives is crucial.
- Facilitating these discussions early, ideally before or upon hospitalization, aids compliance with DNR legislation while respecting patient wishes.