Palliative Care and End of Life Issues |

Decoding Our Perception of DNR: A Survey FREE TO VIEW

Elizabeth Sonntag, MD; Sammy Pedram, MD
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Virginia Commonwealth University, Richmond, VA

Chest. 2015;148(4_MeetingAbstracts):770A. doi:10.1378/chest.2277715
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SESSION TITLE: Palliative Care and End of Life Issues Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Anecdotal evidence shows that there remains confusion within the healthcare community surrounding “do not resuscitate (DNR)” orders. This has the potential to lead to inadequate patient care. The DNR policy at Virginia Commonwealth University Health System (VCUHS) states that a DNR order “prevents initiation of CPR and other resuscitative efforts in patients who sustain a cardiac and/or pulmonary arrest.” The objective was to identify points of confusion within the healthcare community.

METHODS: We conducted an online survey using REDCap (Research Electronic Data Capture). The questions consisted of common medical scenarios. It was voluntary and anonymous. It was distributed to third and fourth year medical students, resident, fellow, and attending physicians, nurses, nurse practitioners and physician’s assistants in all departments at VCUHS. Each question was weighted equally and had one unique correct answer. Nonparametric Mann-Whitney U test was used to compare total scores between healthcare worker groups.

RESULTS: Survey respondents included 56 medical students, 151 residents, 35 fellows, 80 attendings, and 23 “others” (N=345). P-values of <0.05 were considered statistically significant. All groups are individually assessed against the null hypothesis that healthcare workers will score 10 on the survey and the null hypothesis was rejected (p < 0.0001.) The median scores were 6.5, 7, 8, 6 and 7, for medical students, residents, fellows, attendings and others, respectively. When comparing groups, significant p-values of 0.0001 (residents vs. attending physicians) and 0.0087 (fellows vs. attending physicians) were observed suggesting attending physicians are inferior to residents and fellows in knowledge surveyed. Specific topics such as using vasopressors for septic shock, cardioversion of atrial fibrillation, and comfort care orders in patients who have DNR orders were found to be particular areas of confusion.

CONCLUSIONS: There remains misunderstanding of the DNR order amongst all groups of healthcare workers surveyed. Further, attending physicians are potentially inferior in their knowledge when compared to residents and fellows. Specific topics are identified as problem areas.

CLINICAL IMPLICATIONS: End-of-life care continues to be a prominent issue both in healthcare and the media. In order to ensure that adequate and ethically sound care be provided to all patients, it is extremely important that further education is developed to help clinicians understand the difference between DNR and comfort care.

DISCLOSURE: The following authors have nothing to disclose: Elizabeth Sonntag, Sammy Pedram

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