The do-not-resuscitate order: outpatient experience and decision-making preferences

Abstract

Do-not-resuscitate (DNR) orders have become a widespread part of modern medical practice. This study examined patient experience and decision-making preferences regarding cardiopulmonary resuscitation. A random sample of 800 outpatients (one half aged over 70 years) was surveyed by questionnaire, with a 51% response rate. While only 11% of patients had ever discussed resuscitation with a physician, 67% had thought about the issue, and 44% had discussed it with someone other than a physician. Patients overwhelmingly preferred to preserve a good quality of life, even if it meant not living longer (93.9%). When asked who they would have help them with DNR decisions, physicians were most often selected, while spouses were the most valued advisors. In a series of scenarios such factors as dementia, drug or alcohol use, age, and pain had a significant effect on a patient's decision about resuscitation. Discussions about DNR issues in the outpatient setting should be encouraged, as patient interest is strong, and greater physician awareness of patients' values and preferences can prevent unwanted resuscitation in the acute setting.