Palliative Care Center

DNR Orders May Affect Surgical Outcomes

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.

Curtis says that is a trend that is likely to continue and underscores the need for patients to have a frank discussion about their wishes with their health care providers prior to surgery.

"More and more patients, particularly with chronic illness or advanced age, are saying 'I don't want all of this' under normal circumstances, 'I only want it if I can achieve the goals that I would find acceptable.'" says Curtis.