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Related Experiment Videos

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
PubMed
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.

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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.
Keywords:
Beth Israel Medical Center (New York City)Death and EuthanasiaEmpirical ApproachMount Sinai Medical Center (New York City)

Related Experiment Videos

  • 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.