A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

Abstract

Background:The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives.Aim: To determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding.Methods: This was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPRdirective, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire.Results: A total of 1136 patients completed the questionnaire. Patients' CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically. Conclusions:The average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged !80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.

Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study

“…This study revealed a strong correlation between age and DNAR orders, with older patients and their families being more inclined to choose DNAR. These findings align with previous research 22–24. As the population continues to age, the demand for DNAR orders among emergency end-of-life patients is expected to grow even further 23 25.…”

Long-term survival and health-related quality of life after in-hospital cardiac arrest

“…2 As we have previously assessed, knowledge of CPR-directives is often lacking in patients. 17 With our current findings we can improve communication in two ways. First it allows us to reassure young and healthy patients that are overwhelmed by hearing about CPRdirectives, that it seldom occurs and that their prognosis is good.…”

“…4,23-25 EQ-5D-5L visual analogue score was on average 70 at 3 months and 75 at 12 months, where the Dutch population norm is 82 and 62 in Dutch hospitalized patients as described in our previous cross-sectional study. 15,17 Perceived HrQoL (EQ-VAS) in cardiac arrest survivors was lower compared to the Dutch population, but higher than in patients during hospitalization. IHCA survivors perceive less HrQoL than the general population with at least minor problems in all domains of the EQ-5D, but mainly with regard to mobility and daily activities.…”

Do not attempt cardiopulmonary resuscitation decision-making process: scoping review

“…Evidence of decisions being documented varied from 19% to 93.9% in the studies that presented percentages (93.9%, 28 92.3%, 25 91.2%, 45 70.9%, 58 60%, 42 57%-64%, 59 21.2% 44 and 19% 22 ). Coleman et al 24 reported DNACPR decisions recorded and Khalaileh 60 identified DNACPR orders in nursing notes.…”

“…Patient involvement in the decision-making process was reported between 33% and 55% of the time; 33%, 28 48%, 22 52.8% 44 and 55.8%. 45 Almost half of the respondents in one study reported that it was not likely that the patient would be involved in the decision on DNACPR 46 ; while in another study 66% of decisions were made by the medical team without asking the patient or those close to the patient. 26 DNACPR decisions were dominated by the belief that patient inclusion is often pointless.…”