title: Awareness of do-not-resuscitate orders: what do patients know and want?
abstract: OBJECTIVE
  To assess outpatient understanding of and previous experiences with do-not-resuscitate (DNR) orders and to gauge patient preferences with respect to DNR discussions.
  
  
  METHODS
  Cross-sectional, self-administered survey.
  
  
  METHODS
  Four urban primary care physician offices in Vancouver, BC.
  
  
  METHODS
  A total of 429 consecutive patients 40 years of age and older presenting for routine primary care between March and May 2009.
  
  
  METHODS
  Awareness of, knowledge about, and experiences with DNR decisions; when, where, and with whom patients wished to discuss DNR decisions; and differences in responses by sex, age, and ethnicity, assessed using χ² tests of independence.
  
  
  RESULTS
  The response rate was 90%, with 386 of 429 patients completing the surveys. Most (84%) respondents had heard of the terms do not resuscitate or DNR. Eighty-six percent chose family physicians as among the people they most preferred to discuss DNR decisions with; 56% believed that initial DNR discussions should occur while they were healthy; and 46% thought the discussion should take place in the office setting. Of those who were previously aware of DNR orders, 70% had contemplated DNR for their own care, with those older than 60 years more likely to have done so (P = .02); however, only 8% of respondents who were aware of DNR orders had ever discussed the subject with a health care provider. Few patients (16%) found this topic stressful.
  
  
  CONCLUSIONS
  Most respondents were well informed about the meaning of DNR, thought DNR discussions should take place when patients were still healthy, preferred to discuss DNR decisions with family physicians, and did not consider the topic stressful. Yet few respondents reported having had a conversation about DNR decisions with any health care provider. Disparity between patient preferences and experiences suggests that family physicians can and should initiate DNR discussions with younger and healthier patients.
authors.affiliation: St Georges Medical Clinic, North Vancouver, BC.
authors.forename: Claire
authors.initials: C
authors.lastname: Robinson
authors.forename: Sharlene
authors.initials: S
authors.lastname: Kolesar
authors.forename: Mark
authors.initials: M
authors.lastname: Boyko
authors.forename: Jonathan
authors.initials: J
authors.lastname: Berkowitz
authors.forename: Betty
authors.initials: B
authors.lastname: Calam
authors.forename: Marisa
authors.initials: M
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003625:Data Collection; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D014505:Urban Population