Perceptions of care following initiation of do-not-resuscitate orders

Kathryn E. Driggers; Sydney E. Dishman; Kevin K. Chung; Cara H. Olsen; Andrea B. Ryan; Melissa M. McLawhorn; Laura S. Johnson

doi:10.1016/j.jcrc.2022.154008

Perceptions of care following initiation of do-not-resuscitate orders

Kathryn E. Driggers^*, Sydney E. Dishman, Kevin K. Chung, Cara H. Olsen, Andrea B. Ryan, Melissa M. McLawhorn, Laura S. Johnson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

PURPOSE: Documenting do-not-resuscitate (DNR) status in the surgical intensive care unit (ICU) can be controversial; some providers believe that DNR orders change care. This survey evaluates current perceptions.

MATERIALS AND METHODS: IRB approved survey consisting of 31 validated questions divided into 3 factors (1. palliation, 2. active treatment, and 3. trust/communication). Individual questions were compared using Fisher's exact-tests and factors were compared via t-tests.

RESULTS: Both surgical and ICU staff believe care decreases after DNR order initiation (43%). More surgical staff report decreased care aggressiveness versus ICU staff (63% vs 25%, p < 0.005 and Factor 2, 25.8 versus 29.8, p < 0.001), and felt that electrical cardioversion outside of the setting of ACLS would not be performed (57% vs 24%, p < 0.005).

CONCLUSIONS: Surgical staff expressed more concern about care after DNR status than their ICU counterparts. Determining whether care actually changes clinically warrants further investigation.

Original language	English
Article number	154008
Pages (from-to)	154008
Journal	Journal of Critical Care
Volume	69
DOIs	https://doi.org/10.1016/j.jcrc.2022.154008
State	Published - Jun 2022

Keywords

Advance care planning
Advance directives
Cardiopulmonary resuscitation
Critical care
Resuscitation orders
Intensive Care Units
Humans
Electric Countershock
Resuscitation Orders
Communication

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@article{842ea8366abd4f419e7a2158f197f096,

title = "Perceptions of care following initiation of do-not-resuscitate orders",

abstract = "PURPOSE: Documenting do-not-resuscitate (DNR) status in the surgical intensive care unit (ICU) can be controversial; some providers believe that DNR orders change care. This survey evaluates current perceptions.MATERIALS AND METHODS: IRB approved survey consisting of 31 validated questions divided into 3 factors (1. palliation, 2. active treatment, and 3. trust/communication). Individual questions were compared using Fisher's exact-tests and factors were compared via t-tests.RESULTS: Both surgical and ICU staff believe care decreases after DNR order initiation (43%). More surgical staff report decreased care aggressiveness versus ICU staff (63% vs 25%, p < 0.005 and Factor 2, 25.8 versus 29.8, p < 0.001), and felt that electrical cardioversion outside of the setting of ACLS would not be performed (57% vs 24%, p < 0.005).CONCLUSIONS: Surgical staff expressed more concern about care after DNR status than their ICU counterparts. Determining whether care actually changes clinically warrants further investigation.",

keywords = "Advance care planning, Advance directives, Cardiopulmonary resuscitation, Critical care, Resuscitation orders, Intensive Care Units, Humans, Electric Countershock, Resuscitation Orders, Communication",

author = "Driggers, {Kathryn E.} and Dishman, {Sydney E.} and Chung, {Kevin K.} and Olsen, {Cara H.} and Ryan, {Andrea B.} and McLawhorn, {Melissa M.} and Johnson, {Laura S.}",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = jun,

doi = "10.1016/j.jcrc.2022.154008",

language = "English",

volume = "69",

pages = "154008",

journal = "Journal of Critical Care",

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T1 - Perceptions of care following initiation of do-not-resuscitate orders

AU - Driggers, Kathryn E.

AU - Dishman, Sydney E.

AU - Chung, Kevin K.

AU - Olsen, Cara H.

AU - Ryan, Andrea B.

AU - McLawhorn, Melissa M.

AU - Johnson, Laura S.

PY - 2022/6

Y1 - 2022/6

N2 - PURPOSE: Documenting do-not-resuscitate (DNR) status in the surgical intensive care unit (ICU) can be controversial; some providers believe that DNR orders change care. This survey evaluates current perceptions.MATERIALS AND METHODS: IRB approved survey consisting of 31 validated questions divided into 3 factors (1. palliation, 2. active treatment, and 3. trust/communication). Individual questions were compared using Fisher's exact-tests and factors were compared via t-tests.RESULTS: Both surgical and ICU staff believe care decreases after DNR order initiation (43%). More surgical staff report decreased care aggressiveness versus ICU staff (63% vs 25%, p < 0.005 and Factor 2, 25.8 versus 29.8, p < 0.001), and felt that electrical cardioversion outside of the setting of ACLS would not be performed (57% vs 24%, p < 0.005).CONCLUSIONS: Surgical staff expressed more concern about care after DNR status than their ICU counterparts. Determining whether care actually changes clinically warrants further investigation.

AB - PURPOSE: Documenting do-not-resuscitate (DNR) status in the surgical intensive care unit (ICU) can be controversial; some providers believe that DNR orders change care. This survey evaluates current perceptions.MATERIALS AND METHODS: IRB approved survey consisting of 31 validated questions divided into 3 factors (1. palliation, 2. active treatment, and 3. trust/communication). Individual questions were compared using Fisher's exact-tests and factors were compared via t-tests.RESULTS: Both surgical and ICU staff believe care decreases after DNR order initiation (43%). More surgical staff report decreased care aggressiveness versus ICU staff (63% vs 25%, p < 0.005 and Factor 2, 25.8 versus 29.8, p < 0.001), and felt that electrical cardioversion outside of the setting of ACLS would not be performed (57% vs 24%, p < 0.005).CONCLUSIONS: Surgical staff expressed more concern about care after DNR status than their ICU counterparts. Determining whether care actually changes clinically warrants further investigation.

KW - Advance care planning

KW - Advance directives

KW - Cardiopulmonary resuscitation

KW - Critical care

KW - Resuscitation orders

KW - Intensive Care Units

KW - Humans

KW - Electric Countershock

KW - Resuscitation Orders

KW - Communication

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ER -

Perceptions of care following initiation of do-not-resuscitate orders

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