Palliative Surgery in the Do-Not-Resuscitate Patient: Ethics and Practical Suggestions for Management

Scott, Thomas H.; Gavrin, Jonathan R.

doi:10.1016/j.anclin.2012.02.001

Cited by 26 publications

(19 citation statements)

References 16 publications

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“…This act supported patient rights, encouraged patient involvement in the plan of care, allowed patients to consent to or refuse medical treatments, and mandated that institutions honor advance directives. The act stimulated a shift in health care providers’ attitudes and energized patients to challenge the unwritten rule to automatically suspend DNR orders in the OR 3,12,17,18 …”

Section: Description Of the Problemmentioning

confidence: 99%

“…This conversation and reevaluation should be a standard component of care. The risks, benefits, implications, and potential outcomes of anesthesia and surgery in relation to the DNR order must be discussed with the patient before initiating anesthesia and surgery 3,7,17‐21,23 . Nurses are competent and capable of initiating the discussion about DNR orders before surgery, and this is within the scope of nursing practice 24,25 .…”

Section: Description Of the Problemmentioning

confidence: 99%

“…The act stimulated a shift in health care providers' attitudes and energized patients to challenge the unwritten rule to automatically suspend DNR orders in the OR. 3,12,17,18 In 1993, the American Society of Anesthesiologists published statements declaring that a DNR order should be reevaluated for the perioperative period and not suspended automatically. 19 One year later, the American College of Surgeons followed with a congruent statement.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The risks, benefits, implications, and potential outcomes of anesthesia and surgery in relation to the DNR order must be discussed with the patient before initiating anesthesia and surgery. 3,7,[17][18][19][20][21]23 Nurses are competent and capable of initiating the discussion about DNR orders before surgery, and this is within the scope of nursing practice. 24,25 An automatic suspension of the DNR order for surgical patients is unacceptable, unjustifiable, and unethical.…”

Section: Literature Reviewmentioning

confidence: 99%

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Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Baumann¹,

Killebrew²,

Zimnicki³

et al. 2017

AORN Journal

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Do-not-resuscitate (DNR) orders in the perioperative environment must be managed according to national and institutional guidelines. Health care professionals, including perioperative nurses, may be unfamiliar with the guidelines and unsure of their role in reevaluating a DNR order. We conducted a multidisciplinary quality improvement project at a metropolitan community hospital that aimed to improve health care providers' compliance with the institutional policy, nursing involvement in DNR reevaluation, and communication between providers. The project intervention was an educational fair preceded and followed by a survey measuring knowledge about DNR orders, institutional policy, and national guidelines; attitude toward and comfort with the reevaluation process; and the effectiveness of the communication processes. Knowledge of DNR orders improved (P < .0001) for three of four survey questions. Attitude, comfort, and communication also improved (P < .01). A chart audit two months after the intervention showed that compliance with the institutional policy increased by 75%.

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Section: Description Of the Problemmentioning

confidence: 99%

Section: Description Of the Problemmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Baumann¹,

Killebrew²,

Zimnicki³

et al. 2017

AORN Journal

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“…However, complete and entire truth telling in this regard is not defined. In the USA, if a patient does not want CPR, a formal document to that effect must be signed [14]. Similarly, based on the Hospice and Palliative Regulation in Taiwan, a DNR-P consent in Taiwan can be filled out and signed by an adult older than 20 years of age.…”

Section: Introductionmentioning

confidence: 99%

Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients

Wen

Lin

Cheng

et al. 2013

Support Care Cancer

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PurposeDiscussing end-of-life care with patients is often considered taboo, and signing a do-not-resuscitate (DNR) order is difficult for most patients, especially in Chinese culture. This study investigated distributions and details related to the signing of DNR orders, as well as the completeness of various DNR order forms.MethodsRetrospective chart reviews were performed. We screened all charts from a teaching hospital in Taiwan for patients who died of cancer during the period from January 2010 to December 2011. A total of 829 patient records were included in the analysis. The details of the DNR order forms were recorded.ResultsThe DNR order signing rate was 99.8 %. The percentage of DNR orders signed by patients themselves (DNR-P) was 22.6 %, while the percentage of orders signed by surrogates (DNR-S) was 77.2 %. The percentage of signed DNR forms that were completely filled out was 78.4 %. The percentage of DNR-S forms that were completed was 81.7 %, while the percentage of DNR-P forms that were completely filled out was only 67.6 %.ConclusionAlmost all the cancer patients had a signed DNR order, but for the majority of them, the order was signed by a surrogate. Negative attitudes of discussing death from medical professionals and/or the family members of patients may account for the higher number of signed DNR-S orders than DNR-P orders. Moreover, early obtainment of signed DNR orders should be sought, as getting the orders earlier could promote the quality of end-of-life care, especially in non-oncology wards.

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Strategies for Collaborative Consideration of Patients' Resuscitation Preferences

Kopecky

Pelletier

Miller³

2020

AMA Journal of Ethics

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Procedural treatment teams encounter patients with preoperative do-not-resuscitate (DNR) orders who are seeking procedural interventions to improve their quality of life. Required reconsideration is the professional discussion standard that seeks to engage patients or their surrogate decision makers in revisiting patient preferences for rescinding or maintaining a DNR order perioperatively. This article canvasses features of a required reconsideration discussion and guidelines for adhering to this standard. Perioperative DNR Decision MakingSince the passage of the Patient Self-Determination Act in 1990, patients have been legally supported in their right to participate in and direct their own health care decisions. The law itself was written to encourage discussion between health care professionals and patients regarding autonomy, especially at the end of life. 1,2 The tenets of medical ethics similarly support patient autonomy in the context of perioperative decision making, complementing legal perspectives. 3

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Palliative Surgery in the Do-Not-Resuscitate Patient: Ethics and Practical Suggestions for Management

Cited by 26 publications

References 16 publications

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Do‐Not‐Resuscitate Orders in the Perioperative Environment: A Multidisciplinary Quality Improvement Project

Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients

Strategies for Collaborative Consideration of Patients' Resuscitation Preferences

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