Do not resuscitate orders in the perioperative period: patient perspectives

The purpose of this study was to determine the perspectives and opinions of terminally ill patients regarding the management of their do not resuscitate (DNR) orders in the perioperative period. Eighteen patients who had DNR orders and were willing to discuss those orders and their intentions were identified by hospital nurses or hospice workers. An in-depth interview was conducted with each patient. Patients' intentions for DNR orders focused on themes of "being ready to die" and concern regarding financial and emotional cost to themselves and their families. Fifteen of 18 patients would agree to some type of surgery, some to palliative procedures, others to procedures unrelated to their primary disease. After a brief explanation of the different types of anesthesia and their risks, patients were asked how they would like their DNR orders to be respected during the perioperative period. Some would allow procedures in the operating room that ordinarily would be prohibited by a DNR order and felt that DNR orders should be suspended. Many felt that their DNR orders should be discussed with them preoperatively. Some wanted to be involved with decisions regarding specific procedures. Others were satisfied with discussing the intent of their orders. For various reasons and for various procedures, many patients with DNR orders are willing to undergo anesthesia and surgery. Anesthesiologists' awareness of the variety of opinions and perspectives held by patients regarding their DNR orders will enhance their preoperative discussion.