Do patients' ethnic and social factors influence the use of do-not-resuscitate orders?
OBJECTIVE
To determine whether ethnic and other social factors affect how frequently do-not-resuscitate (DNR) orders are written, the timing of DNR orders, or patient involvement in the DNR decision.


METHODS
Retrospective cohort.


METHODS
Patients who died in one urban teaching hospital on the medicine, cardiology, or family practice service during 1988 were eligible; 288 were included in the analyses. Chi-square tests and logistic regression were used to examine frequency of DNR orders and patient involvement; analysis of variance and linear regression were used to examine timing of the DNR orders.


RESULTS
Non-whites were more likely than whites to have DNR orders (OR 1.76; 95% CI, 1.09-2.84) but timing of the DNR order did not vary significantly by race/ethnicity. Patients who spoke English fluently were more likely to be involved in the DNR decision than those who did not (OR 1.28; 95% CI, 1.01-1.61). Patients with documented human immunodeficiency virus were more likely than uninfected patients to have DNR orders (OR 3.51; 95% CI, 1.36-9.02), to be involved in the decision (OR 10.11; 95% CI, 4.87-21.00); and to have DNR orders written earlier (P = 0.02). Alcoholic patients were more likely than non-alcoholics to have DNR orders (OR 1.17; 95% CI, 1.04-1.33).


CONCLUSIONS
Ethnic and other social factors do appear to play a role in DNR decisions. It needs to be determined if these differences are due to patient preferences or clinician characteristics.
Thompson
B L
BL
Department of Medicine, University of California, San Francisco, USA.
Lawson
D
D
Croughan-Minihane
M
M
Cooke
M
M
D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000523:psychology; D001213:Asian / Q000523:psychology*; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000523:psychology; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010358:Patient Participation / Q000523:psychology*; D016414:Resuscitation Orders / Q000523:psychology*; D012189:Retrospective Studies; D012495:San Francisco; D013997:Time Factors; D044465:White People / Q000523:psychology*