TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders

Objectives We quantified the 28-day mortality effect of preexisting do-not-resuscitate orders in ICUs. Design Longitudinal, retrospective study of patients admitted to five ICUs at a tertiary university medical center (Beth Israel Deaconess Medical Center, BIDMC, Boston, MA) between 2001 and 2008. Intervention None. Patients Two cohorts were defined: patients with do not resuscitate advance directives on day 1 of ICU admission and a control group comprising patients with no limitations of level of care on ICU day 1 (full code). Measurements and Main Results The primary outcome was mortality at 28 days after ICU admission. Of 19,007 ICU patients, 1,239 patients (6.5%) had a do-not-resuscitate order on the first day of ICU admission and survived 48 hours in the ICU. We matched those do-not-resuscitate patients with 2,402 patients with full-code status. Twenty-eight day and 1-year mortality were both significantly higher in the do-not-resuscitate group (33.9% vs 18.4% and 60.7% vs 40.2%; p < 0.001, respectively). Conclusion Do-not-resuscitate status is an independent risk factor for ICU mortality. This may reflect severity of illness not captured by other clinical factors, but the perceptions of the treating team related to do-not-resuscitate status could also be causally responsible for increased mortality in patients with do-not-resuscitate status.

show abstract

“…Their survey showed that adding extra contextual information about the patient assisted in resolving the misinterpretation (27, 28). …”

Section: Discussionmentioning

confidence: 99%

Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU*

Fuchs

Anstey

Feng

et al. 2017

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Otherwise, some concern is expressed in the literature that patients with DNR status may receive less aggressive care because of a wrong perception among health care providers that the presence of a DNR mirrors patient's attitude toward overall medical care. 18,19 Lastly, it may be that the patients themselves do not favor aggressive management in the postoperative period because they have been given more time to consider their goals of care or because of an unexpected event in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations

Aziz

Branco

Braun

et al. 2015

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Physicians are not sufficiently trained to discussing resuscitation and can not properly provide information for patients or family members [20]. Moreover, even physicians make erroneous judgments regarding advance directives [22]. If medical professionals express themselves clearly, then that will help patients to understand EOL methods of caring for patients.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders

Cited by 34 publications

References 21 publications

Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU*

Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU*

The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations

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

Contact Info

Product

Resources

About