WE SPEAK FOR DNR

Abstract

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In 1960, Kouwenhoven and colleagues first introduced cardiopulmonary resuscitation (CPR). The decision for a Do Not Resuscitate(DNR) order should be based on a competent patient’s preference or the previously stated advance directive of a patient who is incompetent. Considering the medical ethics of nonmaleficence, the decision to withhold CPR can be justified when the intervention will not benefit the patient. The competence, comfort and familiarity of physicians in addressing DNR orders and other end of life decisions is important for management of patients with terminal illness, as successful end-of-life communication between patients and physicians is associated with superior psychosocial outcomes, less intensive treatment, greater patient satisfaction, and a higher likelihood of death at home. METHODS: The study analyzing the perception of DNR orders amongst physicians from Critical care and Internal Medicine department from a New York community hospital residency/ fellowship training program. The study used a cross-sectional 18-question anonymous online survey about DNR order which was distributed to physicians using surveymoney.com over a span of 5 weeks. RESULTS: Of the 99 completed surveys, 95% of the physicians had performed or taken part in obtaining DNR orders for patients, but only 10% had made a DNR decision for a significant other. Most physicians participating in the DNR discussion were in the initial phases of their medical careers with almost 58%physicians having graduated in the last 5yrs. The lack of personal experience may make these crucial discussions more difficult. 84% survey takers stated that they would like to be DNR themselves with the most important factor to choose DNR being imminent death. CONCLUSIONS: Patients typically rely on physicians to initiate conversations about end-of-life directives, and most seriously ill hospitalized patients prefer to make end-of-life decisions with physician advice. Given our results, we believe that most physicians base their discussion regarding end of life care and advance directive on learned principles and not on experience. In addition the younger physicians who do not have life experience may be unable to empathize with the older population, making the discussion regarding advance directives a mechanical process. This lack of life experience may be overcome with sensitivity training and role play to help alleviate the discomfort associated with such discussions. CLINICAL IMPLICATIONS: Ability to participate in goals of care discussion is an important skill to be honed by physicians in both inpatient and outpatient setting for ensuring appropriate management of patients in accordance with their value. The lack of training in such discussion can lead to a lack of guidance for the patients in settings of terminal illness and inappropriate use of healthcare resources. DISCLOSURES: No relevant relationships by Chetana Pendkar, source=Web Response