An analysis of CPR decision-making by elderly patients.

Sayers, Gwen M; Schofield, Irene; Aziz, Magda Abd El

doi:10.1136/jme.23.4.207

Cited by 34 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…37 65 Some acutely ill hospitalised patients who have been asked what they think about DNR orders have been at increased risk for depression or acute stressors that might impair their judgment. 79 Family members often misinterpret the wishes of elderly relatives. 58 64 80 On one hand, a study showed relatives underestimate the patients' preferences for CPR.…”

Section: Studies Of Patient and Family Attitudes Toward Dnr Ordersmentioning

confidence: 99%

Increasing use of DNR orders in the elderly worldwide: whose choice is it?

Cherniack

2002

J Med Ethics

View full text Add to dashboard Cite

Most elderly patients die with an order in place that they not be given cardiopulmonary resuscitation (DNR order). Surveys have shown that many elderly in different parts of the world want to be resuscitated, but may lack knowledge about the specifics of cardiopulmonary resuscitation (CPR). Data from countries other than the US is limited, but differences in physician and patient opinions by nationality regarding CPR do exist. Physicians' own preferences for CPR may predominate in the DNR decision making process for their patients, and many physicians may not want the participation of the elderly or believe that it is necessary. More complete and earlier discussions of a wider range of options of care for patients at the end of life have been advocated. The process ought to include education for patients about the process and efficacy of CPR, and for physicians on how to consider the values and levels of knowledge of their patients, whose preferences may differ from their own.T he use of do-not-resuscitate (DNR) orders, which preclude the use of cardiopulmonary resuscitation (CPR) has been increasing in all individuals, including the elderly, over the past several decades. 1-11 Several surveys suggest that the majority of hospitalised and institutionalised patients in the United States, and many abroad, die with a DNR order in place, 7 which was not true twenty years ago. The US Patient Self-Determination Act of 1991, which requires patients be informed of their rights to issue advance directives and be involved in medical decision making, appears to have increased the use of DNR orders. 12 While the use of the DNR order has been less systematically studied in other countries, many patients in the developed and developing world also die with a DNR order in place . [12][13][14][15][16][17][18][19][20][21] The elderly are more likely than the young to be the recipients of DNR orders. Most, 6 10 13-15 22-29 but not all 1 surveys indicate older patients, regardless of prognosis, are more frequently given a DNR order than a young patients. It remains an open question, however, whether more elderly people die with a DNR order in place because they are actually choosing to do so. Many studies show that most patients are never asked by a doctor if they wish to be resuscitated, despite a desire to express their wishes. Data from the SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) project, canvassing almost 1000 seriously ill elderly patients, noted that only approximately one quarter had ever discussed CPR with a physician. 30

show abstract

Section: Studies Of Patient and Family Attitudes Toward Dnr Ordersmentioning

confidence: 99%

Increasing use of DNR orders in the elderly worldwide: whose choice is it?

Cherniack

2002

J Med Ethics

View full text Add to dashboard Cite

show abstract

“…15 Usually patients wish to participate in the decision making, 16 but some patients may misunderstand discussions on resuscitation, and, at worst, anxiety may be provoked in others. 17 According to several studies, family members, physicians, and nurses cannot predict patients' treatment choices with sufficient accuracy. 18 In addition patients do not necessarily consider autonomy very important.…”

mentioning

confidence: 99%

End of life decisions: attitudes of Finnish physicians

Hildén

Louhiala²,

Palo³

2004

J Med Ethics

View full text Add to dashboard Cite

Objectives: This study investigated Finnish physicians' experiences of decisions concerning living wills and do not resuscitate (DNR) orders and also their views on the role of patients and family members in these decisions. Design: A questionnaire was sent to 800 physicians representing the following specialties: general practice (n = 400); internal medicine (n = 207); neurology (n = 100), and oncology (n = 93). Results: The response rate was 56%. Most of the respondents had a positive attitude toward (92%), and respect for (86%) living wills, and 72% reported situations in which such a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden (70%) or only palliative (symptom oriented) care required (30%). The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed. Conclusions: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind.

show abstract

“…Although many patients report satisfaction with the DNR discussion [2], a minority of patients (0-40%) experience negative reactions to discussions about life-sustaining treatments, including "puzzlement," "anxiety," "sadness," "hopelessness," and a feeling that the discussion itself was "cruel and insensitive" [8]. Other studies give analogous results: Sayers et al report distress in patients 1 week after the DNR discussion [16] and Singer et al report that patients may consider life-sustaining treatment discussions a private matter that it would be more appropriate for them to have with members of their family than with health care providers [17]. A 1998 study of 33 subjects reports that 6% of the participants did not want the discussion, 3% felt pressured, and 7% did not agree with the conclusion that they should have a DNR order [9].…”

Section: Introductionmentioning

confidence: 80%

Discussion of the do-not-resuscitate order: a pilot study of perceptions of patients with refractory cancer

Pentz

Lenzi

Holmes

et al. 2002

Support Care Cancer

View full text Add to dashboard Cite

Do not resuscitate (DNR) discussions are difficult for physicians and patients alike, resulting in DNR orders being written shortly before death. To understand the patients' point of view, interviews about the perception of DNR discussions were conducted as a pilot study. Fourteen patients with refractory cancer were asked to rank the favorability of DNR discussion scenarios on a Likert scale with 1 meaning most unfavorable and 7 meaning most favorable. The most favorable scenarios were assurance that pain will be controlled (6.9); assurance of nonabandonment (6.9); information about hospice care (6.6); and DNR discussion conducted by attending physician (6.6). The least favorably rated scenarios were delivery of recommendation by physician with whom patient had had no prior contact (1.8); presence of unknown medical personnel with physician (2.0); refusal of physician to answer questions (2.1); and agreement between physician and patient to discuss only positive aspects of patient's case (2.1). This study supports the importance to the patient of a supportive relationship with the attending physician who is both attuned to the need for comprehensive palliative care and is honest about the prognosis.

show abstract

An analysis of CPR decision-making by elderly patients.

Cited by 34 publications

References 13 publications

Increasing use of DNR orders in the elderly worldwide: whose choice is it?

Increasing use of DNR orders in the elderly worldwide: whose choice is it?

End of life decisions: attitudes of Finnish physicians

Discussion of the do-not-resuscitate order: a pilot study of perceptions of patients with refractory cancer

Contact Info

Product

Resources

About