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

2020; Elsevier BV; Volume: 154; Linguagem: Inglês

10.1016/j.resuscitation.2020.04.004

1873-1570

Marc Schluep, Sanne E. Hoeks, Henrik Endeman, Susanne IJmkers, Tessa Romijn, Jelmer Alsma, Frank H. Bosch, Alexander D. Cornet, A.H.M. Knook, A.W.M.M. Koopman-van Gemert, Trudy van Melsen, Ruth Peters, Koen S. Simons, Evert‐Jan Wils, Robert Jan Stolker, Monique van Dijk,

Healthcare Decision-Making and Restraints

BackgroundThe 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.AimTo determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding.MethodsThis 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 CPR-directive, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire.ResultsA 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.ConclusionsThe 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.