The do-not-resuscitate order: a comparison of physician and patient preferences and decision-making

Abstract

Purpose: The purpose of this study was to compare the decision-making and preferences regarding do-not-resuscitate (DNR) orders of a group of family physicians with a group of out-patients from a family practice center. Complete results of the outpatient questionnaire were published in a previous study by the authors.

Subjects and methods: A random sample of 202 members of the Michigan Academy of Family Practice and all 32 members of the University of Michigan Department of Family Practice were surveyed by a mailed questionnaire. The questionnaire was divided into five parts: demographics, past experiences with DNR orders, who should be involved in DNR decision-making, values clarification, and a series of scenarios matched by a variety of biomedical and non-biomedical factors.

Results: After eliminating physicians who had left no forwarding address or who had retired or died, the overall response rate was 61.8%. Most physicians (97%) had at some time written a DNR order for one of their patients; discussions most commonly took place in the hospital room. Physicians, like patients, thought that in addition to the patient, DNR decisions should involve the spouse, the physician, and the patient's children, respectively. Value clarification revealed that both groups most highly value "being able to think clearly" and "being treated with dignity." The presence of a number of quality-of-life issues (age, drug or alcohol use, wheelchair use, dementia, and severe pain) in a series of scenarios negatively affected the decision of both family physicians and patients to resuscitate.

Conclusion: There are significant similarities and differences in the way physicians and patients make DNR decisions. It is important that physicians and their patients communicate in a timely manner about prognosis, values, and quality-of-life issues in order to make effective DNR decisions.