Quality of life of Do-Not-Resuscitate (DNR) patients: how good are physicians in assessing DNR patients' quality of life?
OBJECTIVE
To assess 1) the impact of quality of life evaluation on the implementation of Do-Not-Resuscitate (DNR) orders by physicians, 2) the accuracy of physicians' estimation of DNR patients' quality of life.


METHODS
A 10-month prospective clinical study in a community hospital including 255 DNR patients and 9 physicians in postgraduate training. Outcomes of interest were the influence of quality of life on the DNR decision and the assessment from patients and physicians of five different components related directly or indirectly to quality of life: mental (the Mini Mental State Examination), physical (the Activities of Daily Living) and social (Framingham Disability), degree of pain (visual analogical scale of pain) and of depression (Geriatric Depression Scale).


RESULTS
Quality of life intervened in more than 70% of the DNR decisions. However, physicians underestimated quality of life components of DNR patients (Kappa <0.4 for each functionality). Severe depression, social isolation and physical dependence influenced negatively patients' perception of their quality of life (p <0.01).


CONCLUSIONS
Physicians often (71%) rely on the assumed quality of life of their patients in their DNR decision but unfortunately tend to underestimate it. Greater involvement of patients in the DNR decision could improve quality of care.
Junod Perron
Noëlle
N
Service de médecine interne, Hôpital de la Ville, La Chaux-de-Fonds, Switzerland. noelle.junod@hcuge.ch
Morabia
Alfredo
A
de Torrenté
Antoine
A
D003657:Decision Making; D006801:Humans; D010820:Physicians; D011446:Prospective Studies; D011788:Quality of Life; D016414:Resuscitation Orders