Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan.
BACKGROUND
The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy.


OBJECTIVE
The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy.


METHODS
This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics.


RESULTS
There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity.


CONCLUSIONS
These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.
Campbell
M L
ML
Detroit Receiving Hospital, Mich, USA.
Thill
M C
MC
D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003243:Consciousness; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D012044:Regression Analysis; D016414:Resuscitation Orders; D012189:Retrospective Studies