Navigation Links
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 for the family and other loved ones to come to terms with death before it occurs and less time to provide palliative care to the patient.

The three-year study of 668 adults age 65 and older in a large, urban public hospital found that surrogate decision-making is the norm rather than the exception. Surrogates made the DNR decision 58 percent of the time. Patients who were unable to make their own decisions and required a surrogate were more likely to be in the Intensive Care Unit (ICU) but did not differ by demographic characteristics from those able to make their own decisions.

For surrogates, DNR decision-making appears to be a process rather than a single event and may require more than one conversation with health care provides , which may contribute to longer times to reach decisions, the researchers note. Previous studies have found that delays in DNR decision-making are associated with higher hospital costs and longer lengths of stay compared to patients whose DNR orders were written at the time of admission.

Surrogate decision making is likely to become even more common as the population ages and the prevalence of dementia and delirium increases. The researchers call for further study to see if supporting surrogates in their decision making can reduce delays in DNR decisions and impact elements of patient care, such as length of stay or cost.


'/>"/>

Contact: Cindy Fox Aisen
caisen@iupui.edu
317-274-7722
Indiana University School of Medicine
Source:Eurekalert  

Related medicine news :

1. Better learning through handwriting
2. Widening our perceptions of reading and writing difficulties
3. For Teens With Autism, Handwriting Problems May Persist
4. Writing checks that bounce: World continues to backtrack on HIV treatment
5. High School Students Well-Schooled In Diversity: Teen Winners of Book Writing Contest Earn College Scholarships and Have Entries Published
6. Facebook Group for McNeil Product Recall Organizes Letter Writing Campaign – Urges Concerned Parents to Contact House of Representatives and Senators
7. Vasont Systems Contributes Content Management Expertise to New Book on Virtual Collaborative Writing
8. Previous cancer history increases chances of clotting disorders after knee surgery, study suggests
9. Eating Disorders Appear to Raise Risk of Death
10. Eating Disorders May Raise Risk of Depression in Pregnancy
11. City Living Tied to More Anxiety, Mood Disorders
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Writing DNR orders takes longer, death more likely when surrogate decision-maker involved
(Date:1/18/2017)... ... 2017 , ... At Hallmark Nameplate, their commitment to quality is what sets ... ISO 13485. This certification is another way they are making constant strides to provide ... they need. , The ISO 13485 Certification is a major accomplishment for Hallmark Nameplate ...
(Date:1/18/2017)... ... January 18, 2017 , ... Michael ... new website for its Center for Biosimilars, announced Michael J. Hennessy Associates, Inc. ... in the field of biosimilars through thought leader interaction in, live video and ...
(Date:1/18/2017)... (PRWEB) , ... January 18, 2017 , ... ... problems ranging from gum disease to enamel erosion, and those dental problems can ... Department of Public Health, many pregnant women are failing to get the dental ...
(Date:1/17/2017)... ... January 17, 2017 , ... Anesthesia Progress – Everyone ... choose the best drug option for each patient. Dentists have several general anesthesia alternatives ... outcomes. , Researchers from the Tokyo Dental College in Tokyo, Japan wanted to find ...
(Date:1/17/2017)... ... January 17, 2017 , ... For breast cancer clinicians and researchers ... those who desire a more intimate review and analysis of its highlights, a novel ... Bedside—is being offered by Imedex on February 4, 2017 in Chicago. Chaired by Kathy ...
Breaking Medicine News(10 mins):
(Date:1/18/2017)... 2017   Spotlight Innovation Inc. (OTCQB: ... in the second quarter of 2017, to launch ... to provide relief from chronic pain, is a ... was developed under a licensing agreement with Dr. ... from snake venom. Additionally, Caretta Therapeutics has signed ...
(Date:1/18/2017)... , Jan 18, 2017 Research and Markets ... Vomiting Drugs Market 2017-2021" report to their offering. ... The global CINV drugs ... 2017-2021. Global Thoracic Surgery Market 2017-2021, has been ... experts. The report covers the market landscape and its growth prospects ...
(Date:1/18/2017)... -- In China , we say Health ... of China,s Healthy Strategy originates. 2016 ... Economic and Social Development of the People,s Republic ... state council of the People,s Republic of China ... development plan, identifying medical devices as one of the main ...
Breaking Medicine Technology: