The do-not-resuscitate order: Associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act

E. D. Morrell, B. P. Brown, R. Qi, K. Drabiak, Paul Helft

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Since the passage of the Patient Self-Determination Act, numerous policy mandates and institutional measures have been implemented. It is unknown to what extent those measures have affected end-of-life care, particularly with regard to the do-not-resuscitate (DNR) order. Methods: Retrospective cohort study to assess associations of the frequency and timing of DNR orders with advance directive status, patient demographics, physician's specialty and extent of documentation of discussion on end-of-life care. Results: DNR orders were more frequent for patients on a medical service than on a surgical service (77.34% vs 64.20%, p=0.02) and were made earlier in the hospital stay for medicine than for surgical patients (adjusted mean ratio of time from DNR orders to death versus total length of stay 0.30 for internists vs 0.21 for surgeons, p=0.04). 22.18% of all patients had some form of an advance directive in their chart, yet this variable had no impact on the frequency or timing of DNR ordering. Documentation of DNR discussion was significantly associated with the frequency of DNR orders and the time from DNR to death (2.1 days with no or minimal discussion vs 2.8 days with extensive discussion, p<0.01). Conclusions: The physician's specialty continues to have a significant impact on the frequency and timing of DNR orders, while advance directive status still has no measurable impact. Additionally, documentation of end-of-life discussions is significantly associated with varying DNR ordering rates and timing.

Original languageEnglish
Pages (from-to)642-647
Number of pages6
JournalJournal of Medical Ethics
Volume34
Issue number9
DOIs
StatePublished - Sep 1 2008

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Patient Self-Determination Act
Resuscitation Orders
Advance Directives
self-determination
Documentation
documentation
act
physician
Physicians
Terminal Care
death
medical service
Length of Stay
Organizational Policy
Hospital Medicine
medicine
Self-determination
Cohort Studies
Retrospective Studies
Demography

ASJC Scopus subject areas

  • Health Policy
  • Health(social science)
  • Issues, ethics and legal aspects

Cite this

The do-not-resuscitate order : Associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act. / Morrell, E. D.; Brown, B. P.; Qi, R.; Drabiak, K.; Helft, Paul.

In: Journal of Medical Ethics, Vol. 34, No. 9, 01.09.2008, p. 642-647.

Research output: Contribution to journalArticle

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abstract = "Background: Since the passage of the Patient Self-Determination Act, numerous policy mandates and institutional measures have been implemented. It is unknown to what extent those measures have affected end-of-life care, particularly with regard to the do-not-resuscitate (DNR) order. Methods: Retrospective cohort study to assess associations of the frequency and timing of DNR orders with advance directive status, patient demographics, physician's specialty and extent of documentation of discussion on end-of-life care. Results: DNR orders were more frequent for patients on a medical service than on a surgical service (77.34{\%} vs 64.20{\%}, p=0.02) and were made earlier in the hospital stay for medicine than for surgical patients (adjusted mean ratio of time from DNR orders to death versus total length of stay 0.30 for internists vs 0.21 for surgeons, p=0.04). 22.18{\%} of all patients had some form of an advance directive in their chart, yet this variable had no impact on the frequency or timing of DNR ordering. Documentation of DNR discussion was significantly associated with the frequency of DNR orders and the time from DNR to death (2.1 days with no or minimal discussion vs 2.8 days with extensive discussion, p<0.01). Conclusions: The physician's specialty continues to have a significant impact on the frequency and timing of DNR orders, while advance directive status still has no measurable impact. Additionally, documentation of end-of-life discussions is significantly associated with varying DNR ordering rates and timing.",
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