Abstract
Although patient preferences are important in decisions about “do not resuscitate” (DNR) orders, little is known about how physicians discuss these orders with patients. We asked 15 physicians to simulate discussing such orders with a patient. We found a striking variation in whether physicians explicitly asked for patient preferences, how they described cardiopulmonary resuscitation (CPR) and its possible outcomes and whether they made a recommendation to the patient about DNR orders. There was no pattern to the different amounts of information presented about CPR. Physicians gave conflicting reasons for how they individualized discussions with patients. Awareness of such different behaviors may stimulate physicians to examine what they say to patients about this sensitive and important topic and why they say it.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bedell S. E., Delbanco T. L., Cook E. F., Epstein F. H. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983 Sep 8;309(10):569–576. doi: 10.1056/NEJM198309083091001. [DOI] [PubMed] [Google Scholar]
- Ingelfinger F. J. Arrogance. N Engl J Med. 1980 Dec 25;303(26):1507–1511. doi: 10.1056/NEJM198012253032604. [DOI] [PubMed] [Google Scholar]
- Lo B., Jonsen A. R. Ethical dilemmas and the clinician. Ann Intern Med. 1980 Jan;92(1):116–117. [PubMed] [Google Scholar]
- Lo B., Steinbrook R. L. Deciding whether to resuscitate. Arch Intern Med. 1983 Aug;143(8):1561–1563. [PubMed] [Google Scholar]
- McNeil B. J., Weichselbaum R., Pauker S. G. Fallacy of the five-year survival in lung cancer. N Engl J Med. 1978 Dec 21;299(25):1397–1401. doi: 10.1056/NEJM197812212992506. [DOI] [PubMed] [Google Scholar]
- Miles S. H., Cranford R., Schultz A. L. The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy. Ann Intern Med. 1982 May;96(5):660–664. doi: 10.7326/0003-4819-96-5-660. [DOI] [PubMed] [Google Scholar]
- Thomasma D. C. Beyond medical paternalism and patient autonomy: a model of physician conscience for the physician-patient relationship. Ann Intern Med. 1983 Feb;98(2):243–248. doi: 10.7326/0003-4819-98-2-243. [DOI] [PubMed] [Google Scholar]