Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium.
OBJECTIVE
To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation.


METHODS
Structured mail questionnaires.


METHODS
All 94 acute geriatric wards in hospitals in Flanders in 2002 (the year Belgium voted a law on euthanasia).


METHODS
Head geriatricians.


METHODS
A questionnaire was mailed about the existence, development, and implementation of the DNR policy (guidelines and order forms), with a request to return copies of existing DNR guidelines and DNR order forms.


RESULTS
The response was 76.6%, with hospital characteristics not significantly different for responders and nonresponders. Development of DNR policy began in 1985, with a step-up in 1997 and 2001. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. Geriatric wards in private hospitals implemented their policy later (P=.01) and more often had order forms (P=.04) than those in public hospitals. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process.


CONCLUSIONS
Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions.
De Gendt
Cindy
C
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium. cindy.de.gendt@vub.ac.be
Bilsen
Johan
J
Vander Stichele
Robert
R
Lambert
Margareta
M
Den Noortgate
NeleVan
N
Deliens
Luc
L
D000368:Aged; D001530:Belgium; D005568:Forms and Records Control; D005853:Geriatrics / Q000592:standards*; D019538:Health Care Surveys; D006739:Hospital Administration / Q000592:standards*; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D018447:Medical Futility; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D016414:Resuscitation Orders; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires