Do-not-resuscitate discussions: a qualitative analysis.
The literature to date on Do-Not-Resuscitate (DNR) decision-making is based upon data derived from structured questionnaires, hypothetical scenarios, descriptive epidemiology, or simulated discussions. Lacking in the literature has been a critical examination of the health care professional-patient-family relationship and its impact on decision-making regarding resuscitation. The purpose of this study is to identify and describe organizational and communication factors that affect the process and outcome of DNR discussions and decision-making. Individual and focus-group interviews were conducted with sixteen key informants professionally knowledgeable about resuscitative issues. Thematic analysis of these interviews revealed that a variety of cultural and professional values, as well as previous personal experiences, influenced the assumptions that providers made when engaging in DNR decision-making. Specific recommendations are made to help family physicians identify communication strategies that foster understanding and lead to participatory decisions about resuscitation among patients and families.
Ventres
W
W
Department of Family and Community Medicine, University of Arizona, Tucson.
Nichter
M
M
Reed
R
R
Frankel
R
R
D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D004992:Ethics, Medical; D005190:Family; D006801:Humans; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012106:Research; D016414:Resuscitation Orders