How misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders

Abstract

Context: On hospital admission, many elderly patients make the decision to enact a do-not-resuscitate (DNR) order. However, few studies have evaluated the beliefs of elderly patients regarding the likelihood of surviving cardiopulmonary resuscitation (CPR) if it should become necessary during their hospitalization.

Objectives: To quantify elderly patients' beliefs about their chances of survival to discharge following CPR; to ascertain the sources of information that may lead to these beliefs; and to determine how these beliefs affect decisions regarding DNR orders.

Methods: An oral standardized survey was administered to 100 patients aged 70 years or older. Patients were randomly selected from the emergency department, internal medicine clinic, and general medical wards at one urban medical center.

Results: Most respondents (81%) believed that their chance of surviving inpatient CPR and leaving the hospital was 50% or better, and 23% of those respondents believed that their chance was 90% or better. Forty-four percent of patients reported having a standing DNR order. Most patients reported obtaining healthcare information from television, physicians, or both.

Conclusion: Elderly patients often hold erroneous beliefs regarding the outcomes of inpatient CPR. A significant number of our participants had standing DNR orders despite demonstrating extremely optimistic beliefs about CPR. Educating patients and their families about these poor outcomes would allow them to make more informed decisions regarding end-of-life issues.