Residents?? End-of-Life Decision Making with Adult Hospitalized Patients: A Review of the Literature

Gorman, Todd; Ahern, Stéphane P.; Wiseman, Jeffrey; Skrobik, Yoanna

doi:10.1097/00001888-200507000-00004

Cited by 75 publications

(59 citation statements)

References 34 publications

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“…Second, the development and implementation of a clear and standardized DNR policy, accepted by all persons concerned and recognizing the important role of all professional caregivers (especially nurses), should be stimulated. Third, ongoing efforts should be made to change the knowledge, communication skills, and attitudes of professional health caregivers (physicians, nurses) (32). In addition, the general public should be made more familiar with this matter, for example, by health information programs.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Patients With Do-Not-Resuscitate Status on Acute Geriatric Wards in Flanders, Belgium

Gendt¹,

Bilsen²,

Noortgate³

et al. 2007

The Journals of Gerontology Series A: Biological Sciences and M

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Section: Discussionmentioning

confidence: 99%

Prevalence of Patients With Do-Not-Resuscitate Status on Acute Geriatric Wards in Flanders, Belgium

Gendt¹,

Bilsen²,

Noortgate³

et al. 2007

The Journals of Gerontology Series A: Biological Sciences and M

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“…39 In one survey of 155 medicine and surgery residents, 43% would withhold blood products and 32% would not give antibiotics to a patient with a DNR order. 40 Some believe that diagnostic tests should not be ordered when a patient is "DNR." This may be due to misunderstanding the scope of DNR orders by some providers.…”

Section: Problems With Dnr Orders In Practicementioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes-to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient selfdetermination and avoiding non-beneficial interventions at the end of life.KEY WORDS: do-not-resuscitate orders; informed consent; end-of-life care.

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“…It revealed that little is known about their training needs and experiences while caring for critically ill patients at EOL (Gorman et al 2005). An interview-based qualitative study was then conducted to identify what is important to physician trainees in ICU and infer on positive educational experiences for physician trainees.…”

Section: Introductionmentioning

confidence: 99%

Critically ill patients and end-of-life decision-making: the senior medical resident experience

Ahern

Doyle

Marquis

et al. 2011

Adv in Health Sci Educ

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In order to improve the understanding of educational needs among residents caring for the critically ill, narrative accounts of 19 senior physician trainees participating in level of care decision-making were analyzed. In this multicentre qualitative study involving 9 university centers in Canada, in-depth interviews were conducted in either English or French, and the transcripts then underwent a hermeneutic phenomenological analysis. The resident was the central figure in the narrated incident, along with the patients' relatives and other attending physicians. The vast majority of interviews recounted negative experiences that involved delivering bad news to patients' families and managing difficult communications with them and with physician colleagues. Emotional distress and suffering were often part of their decision-making process. Narrating their experiences was viewed as a positive event. Data analysis uncovered 6 general themes that were organized into 2 categories, the first one grouping together themes related to interactions with the patients' families and the second comprising themes related to interactions with physician coworkers. The findings suggest that physician trainees' narratives are a rich source of data regarding what constitutes meaningful training experiences and what they learn from them. Educational approaches that incorporate the telling of stories would allow students to express their feelings, doubts, and opinions about their work experiences and could thus foster personal and emotional learning in critical care.

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Residents?? End-of-Life Decision Making with Adult Hospitalized Patients: A Review of the Literature

Cited by 75 publications

References 34 publications

Prevalence of Patients With Do-Not-Resuscitate Status on Acute Geriatric Wards in Flanders, Belgium

Prevalence of Patients With Do-Not-Resuscitate Status on Acute Geriatric Wards in Flanders, Belgium

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

Critically ill patients and end-of-life decision-making: the senior medical resident experience

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