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Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate

BACKGROUND: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretat...

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Autores principales: Pirinea, Heather, Simunich, Thomas, Wehner, Daniel, Ashurst, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072235/
https://www.ncbi.nlm.nih.gov/pubmed/27803565
http://dx.doi.org/10.4103/0973-1075.191784
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author Pirinea, Heather
Simunich, Thomas
Wehner, Daniel
Ashurst, John
author_facet Pirinea, Heather
Simunich, Thomas
Wehner, Daniel
Ashurst, John
author_sort Pirinea, Heather
collection PubMed
description BACKGROUND: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs. METHODOLOGY: An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected. RESULTS: A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453–2.804]) or DNI (95% CI (1.216–2.334)) 52% of the time while HCPs 35% and 39% of the time (P < 0.0005). Regarding the POLST form, 86% of patients and PFMs and 50% of HCPs were not familiar with the POLST form. Sixty-nine percent of patients and family members reported that their primary care physician had not discussed advance directives with them. Twenty-four percent of patients and family members reported that they had previous health-care experience and this was associated with increased knowledge of the POLST form (P < 0.0005). An association was also seen between the type of HCP taking the survey and the ability to correctly identify the correct definition of DNR (P < 0.0005). CONCLUSION: Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI, and the POLST form. Education of patients, family members, and HCPs is required to bridge the knowledge gap of advance directives.
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spelling pubmed-50722352016-11-01 Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate Pirinea, Heather Simunich, Thomas Wehner, Daniel Ashurst, John Indian J Palliat Care Original Article BACKGROUND: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs. METHODOLOGY: An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected. RESULTS: A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453–2.804]) or DNI (95% CI (1.216–2.334)) 52% of the time while HCPs 35% and 39% of the time (P < 0.0005). Regarding the POLST form, 86% of patients and PFMs and 50% of HCPs were not familiar with the POLST form. Sixty-nine percent of patients and family members reported that their primary care physician had not discussed advance directives with them. Twenty-four percent of patients and family members reported that they had previous health-care experience and this was associated with increased knowledge of the POLST form (P < 0.0005). An association was also seen between the type of HCP taking the survey and the ability to correctly identify the correct definition of DNR (P < 0.0005). CONCLUSION: Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI, and the POLST form. Education of patients, family members, and HCPs is required to bridge the knowledge gap of advance directives. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC5072235/ /pubmed/27803565 http://dx.doi.org/10.4103/0973-1075.191784 Text en Copyright: © Indian Journal of Palliative Care http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Pirinea, Heather
Simunich, Thomas
Wehner, Daniel
Ashurst, John
Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate
title Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate
title_full Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate
title_fullStr Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate
title_full_unstemmed Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate
title_short Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate
title_sort patient and health-care provider interpretation of do not resuscitate and do not intubate
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072235/
https://www.ncbi.nlm.nih.gov/pubmed/27803565
http://dx.doi.org/10.4103/0973-1075.191784
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