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Patient and Family Involvement

Developing a Policy for Do Not Resuscitate Orders Within a Framework of Goals of Care

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Abstract:

Background: Discussions about DNR (do not resuscitate) orders or code status are common but can be difficult and may not lead to accurate understanding between clinicians and patients. These discussion are often isolated from the larger context of a patient's plan of care. Addressing patients' goals of care, which provide a basic orientation for clinical and ethical decision making, may improve clinicians' understanding about patients' code-status preferences.

A Policy for DNR Orders Within a Framework of Goals of Care: On the basis of experience at the University of Iowa Hospitals and Clinics, which entailed incorporating goals of care in ethics education, identifying six goals of care through a structured literature review, surveying hospitalized adults, and integrating goals of care into palliative care education, the University of Iowa Hospitals and Clinics ethics committee revised the hospital policy regarding DNR orders. The intention was to avoid treating DNR orders as an isolated clinical phenomenon and to instead place the discussion of DNR orders in the more general context of end-of-life discussions and to place both of these discussions within an even more general framework of goals of care.

Conclusions: The DNR order policy represents an effort to translate conceptual analysis, empirical research, and clinical experience into hospital policy so that clinicians are encouraged to place code-status discussions within a larger, goal-oriented context. Using goals of care to guide decision making about DNR orders and other treatments should enhance the quality of patient care by improving the fit between the biomedical information we provide patients and the values our patients rely on to make their medical decisions.

Document Type: Research Article

Publication date: 2011-01-01

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  • The Joint Commission Journal on Quality and Patient Safety will be published by Elsevier beginning in 2017! For readers who receive access to the journal through their institutions, the journal can now be found on ScienceDirect (http://www.sciencedirect.com/science/journal/15537250). For librarians looking to subscribe to the journal for their institutions please contact your Elsevier Account Manager or visit www.myelsevier.com for more information. All other readers, please visit http://www.jointcommissionjournal.com/ to subscribe to the journal or to claim your access for an existing subscription.
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