Allow natural death versus do-not-resuscitate: titles, information contents, outcomes, and the considerations related to do-not-resuscitate decision

BMC Palliat Care. 2018 Oct 10;17(1):114. doi: 10.1186/s12904-018-0367-4.

Abstract

Background: As the "do not resuscitate" (DNR) discussion involves communication, this study explored (1) the effects of a title that included "allow natural death", and of information contents and outcomes of the decision; and (2) the information needs and consideration of the DNR decision, and benefits and barriers of the DNR discussion.

Methods: Healthy adults (n = 524) were presented with a scenario with different titles, information contents, and outcomes, and they rated the probability of a DNR decision. A questionnaire including information needs, consideration of the decision, and benefits and barriers of DNR discussion was also used.

Results: There was a significantly higher probability of signing the DNR order when the title included "allow natural death" (t = - 4.51, p < 0.001), when comprehensive information was provided (F = 60.64, p < 0.001), and when there were worse outcomes (F = 292.16, p < 0.001). Common information needs included remaining life period and the prognosis. Common barriers were the families' worries and uncertainty about future physical changes.

Conclusion: The title, information contents, and outcomes may influence the DNR decisions. Health-care providers should address the concept of natural death, provide comprehensive information, and help patients and families to overcome the barriers.

Keywords: Allow natural death; Barriers; Cardiopulmonary resuscitation; Do not resuscitate; Information needs.

MeSH terms

  • Adult
  • Cardiopulmonary Resuscitation* / ethics
  • Cardiopulmonary Resuscitation* / psychology
  • Communication Barriers
  • Decision Making*
  • Disclosure*
  • Euthanasia, Passive* / ethics
  • Euthanasia, Passive* / psychology
  • Female
  • Humans
  • Male
  • Needs Assessment
  • Qualitative Research
  • Resuscitation Orders* / ethics
  • Resuscitation Orders* / psychology
  • Social Perception
  • Taiwan
  • Terminal Care* / ethics
  • Terminal Care* / methods
  • Terminal Care* / psychology
  • Truth Disclosure