10 Sep DNR: Clinical Perspectives
MedicalResearch.com Interview with:
Dr. Amy Sanderson MD
Department of Anesthesiology
Perioperative & Pain Medicine
Boston Children’s Hospital
MedicalResearch.com: What are the main findings of the study?
Dr. Sanderson: There is substantial variability in the interpretation of a DNR order. 66.9% of clinicians believed that a DNR order indicates limitation of resuscitative measures only on cardiopulmonary arrest, whereas 33.1% considered a DNR order to be the threshold for the limitation of treatments not specifically related to resuscitation. 68.7% of clinicians reported that the care of a patient changes once a DNR order is written. Of those reporting changes in care, 11.2% reported that this happens only if a cardiopulmonary arrest occurs, while 36.7% believed that there is an increased attention to comfort. Finally, 52.1% reported that care changes beyond both resuscitative measures and focusing on comfort, including limitation or withdrawal of diagnostic and therapeutic interventions. Most clinicians reported that resuscitation status discussions happen later in the illness course than is ideal.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Sanderson: We found it encouraging that the vast majority of clinicians did not feel that they were giving up on their patients once a Do-Not-Resuscitate order is in effect since we believe that clinicians can offer optimal care to patients regardless of their resuscitation status.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Sanderson: Clinicians use the DNR order not only as a guide for therapeutic decisions during a cardiopulmonary arrest but also as a surrogate for broader treatment directives. Most clinicians believe that DNR discussions should take place earlier than they actually do.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Sanderson: Interventions aimed at improving clinician knowledge and skills in advance care discussions as well as the development of orders that address overall goals of care may improve care for children with serious illness.
Sanderson A, Zurakowski D, Wolfe J.
Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts.JAMA Pediatr. 2013 Aug 26. doi: 10.1001/jamapediatrics.2013.2204. [Epub ahead of print]