DNR Orders May Affect Surgical Outcomes
People With Do-Not-Resuscitate Orders More Likely to Die Soon After Surgery
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DNR Orders Misinterpreted?
A do-not-resuscitate order is a legal form instructing health care providers that cardiopulmonary resuscitation (CPR) and other measures should not be performed in the event that the patient’s heartbeat stops.
But Braddock, who is also director of clinical ethics at Stanford's Center for Biomedical Ethics, says some health care providers can take the intent of a DNR order even more broadly. He says previous studies have also shown that DNR orders subconsciously affect how doctors and nurses treat patients. For example, they order fewer tests and don't enter the patient's room as often.
"I do not believe that most patients, as part of the informed consent process around DNR, are aware that it might inadvertently lead to less intensive care," says Braddock.
Frank DNR Discussion Needed
That's why researchers say it's important for patients to talk to their doctors not only about DNR status but the bigger picture of the goals of their treatment and care.
"If someone says, 'If my heart stops, I don't want it to be restarted,' that is one thing, but if they say something broad like, 'I don't want you to use extreme measures,' What do extreme measures mean? I think that is fuzzier," says Roman.
"It is important to have the conversation in more detail between physician and patient," says Roman. "So physicians can understand their patients' wishes better, and the patient understands the risks and outcomes better by knowing what to expect if certain things happen."
Some experts also say it would be a mistake to misinterpret the study results as saying DNR status automatically means a worse prognosis after surgery for everyone.
"For patients who do decide to become DNR, this study shows outcomes for surgery are significantly less," says J. Randall Curtis, MD, MPH, professor of medicine at the University of Washington, Seattle. "That doesn't mean surgery is not worth trying necessarily, but it is important to understand that it is riskier than for patients who are healthier."
Researchers say the use of DNR orders has been increasing in recent years, and up to 15% of people with a DNR have surgery.