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Writing DNR orders takes longer, death more likely when surrogate decision-maker involved
Date:7/11/2011

INDIANAPOLIS Indiana University and Regenstrief Institute researchers report that it takes significantly longer for orders to forgo resuscitation in the event of cardiac arrest to be written for patients who had that decision made for them by a surrogate decision-maker compared to patients who made their own decisions, even though patients with a surrogate were sicker and the resuscitation issue might arise sooner. Among patients who died, patients with a surrogate had a shorter time frame between writing the DNR order and time of death compared to patients who made their own decisions.

"Surrogate decision making is not just more challenging for everyone, it actually affects important care processes in the hospitalin this case, code orders," said lead author Regenstrief Institute investigator Alexia Torke, M.D., assistant professor of medicine at the IU School of Medicine. "The delay in DNR orders may be due to the more complex ethical and communication issues involved in surrogate decision-making compared to patient decision-making. For a variety of reasons, including not being sure of what the patient would want, surrogates may have difficulty making the DNR decision."

"The Timing of Do Not Resuscitate Orders for Hospitalized Older Adults Who Require a Surrogate Decision Maker" appears in the July 2011 issue of the Journal of the American Geriatrics Society.

For every patient admitted to the hospital, a decision needs to be made about whether to resuscitate if the heart or breathing stops. If no decision is made, the patient is generally assumed to be "full code" and full resuscitation will be given, if needed. Some patients decide to have DNR orders, so if their heart or breathing were to stop they would be kept comfortable and allowed to die naturally. Dr. Torke notes that the shorter time frame between the decision to write a DNR order, if a surrogate is involved, and cardiac arrest, allows less of an opportunity
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Contact: Cindy Fox Aisen
caisen@iupui.edu
317-274-7722
Indiana University School of Medicine
Source:Eurekalert  

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Writing DNR orders takes longer, death more likely when surrogate decision-maker involved
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