Surrogates' predictions of seriously ill patients' resuscitation preferences

Pm, Layde; Ca, Beam; Sk, Broste; Connors, Alfred F.; Desbiens, Norman A.; Lynn, Joanne; Rs, Phillips; Reding, Douglas J.; Teno, Joan M.; Vidaillet, Humberto

doi:10.1001/archfami.4.6.518

Cited by 103 publications

(74 citation statements)

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“…This might have eliminated patients who became upset or angry when the team discussed the subject with them, so we may have missed some of the important patient perspectives that exist in instances of conflict. In addition, we did not interview surrogate decisionmakers, whose perspectives and decisions may be different from those of the patient 17,37 . Based on the results of this study, we might speculate that instances of discordance could reflect differences in perspectives about symptoms, quality of life, goals of care, the stage of illness (early vs. late), the utility of resuscitation, and the relational view of the patient within his/her family.…”

Section: Discussionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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BACKGROUND:The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status. METHODS:We conducted semi-structured interviews of English-speaking medical inpatients who had clearly requested a DNR or full code (FC) order after a discussion with their admitting team, and analyzed the transcripts using a modified grounded-theory approach. RESULTS:We achieved conceptual saturation after conducting 44 interviews (27 DNR, 17 FC) over a 4-month period. Patients in the DNR group were much older than those in the FC group, but they had broadly similar admission diagnoses and comorbidities. DNR patients reported much greater familiarity with the subject and described a more positive experience than FC patients with their resuscitation discussions. Participants typically requested FC or DNR orders based on personal, relational or philosophical considerations, but these considerations manifested differently depending on the participant's preference for resuscitation. Most FC patients stated that would not want a prolonged period of life support, and they would not want resuscitation in the event of a poor quality of life. FC and DNR patients understood resuscitation and DNR orders differently. DNR patients described resuscitation in graphic, concrete terms that emphasized suffering and futility, and DNR orders in terms of comfort or natural processes. FC patients understood resuscitation in an abstract sense as something that restores life, while DNR orders were associated with substandard care or even euthanasia.CONCLUSION: Our study identified important differences and commonalities between the perspectives of DNR and FC patients. We hope that this information can be used to help physicians better understand the needs of their patients when discussing resuscitation.

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Section: Discussionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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“…For example, although documents on advance decisions, including surrogate designation, are available in the United States, few people use them, even when interventions specifically designed to increase their use are implemented [21,22,23,24,25,26]. Moreover, it has been reported that surrogates may not view their responsibilities in the same way as the patients they represent [27,28].…”

Section: Discussionmentioning

confidence: 99%

Patients' preferences concerning medical information and surrogacy: results of a prospective study in a French emergency department

Roupie

Santin

Boulmé

et al. 2000

Intensive Care Medicine

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Our patients expressed a strong desire to receive extensive information should they become seriously ill, and two-thirds of them reported they would want a surrogate. However, only 40.6 % of the patients living with a spouse/partner would want their spouse/partner to be their surrogate. These data suggest that the time has probably come to propose a nation-wide public hearing on medical information and surrogacy in France.

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“…17,18,21,[25][26][27][28][29][30][31][32] In such studies, individuals are asked what they would want for themselves in particular circumstances. Their loved ones or designated proxies are then asked to predict what the patient would have wanted.…”

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%