1605P - Opinions of nurses on the application and implications of DNR/DNI orders

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Supportive Care
Presenter Isabella Glitza
Authors I.C. Glitza1, H.J. Conter2, R. Turner3, S.K. Reddy4, E. Bruera5
  • 1Division Of Hematology/oncology, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 2Division Of Cancer Medicine, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 3Palliative Care, Albert Einstein Medical Center, 19141 - Philadelphia/US
  • 4Department Of Palliative Care And Rehabilitation Medicine, MD Anderson Cancer Center, 77030 - Houston/US
  • 5Palliative Care And Rehabilitation Medicine, M.D. Anderson Cancer Center, 77030 - Houston/US

Abstract

Background

Although do not resuscitate (DNR)/ do not intubate (DNI) orders have a technically limited mandate, the implication of such orders may be broad. Moreover, the patient factors that may influence healthcare providers' decisions may be debated. This study aimed to evaluate nurses' opinions on DNR/DNI orders.

Methods

The study was conducted as an anonymous, single institution survey. Fulltime nurses (RNs) were identified by payroll and received a questionnaire. Nurses' demographics and background, their rating of factors leading to DNR/DNI and rating of appropriateness of treatments were obtained.

Results

Of the 350 distributed surveys, 83% were returned. Work locations included general floors (47%), intermediate care (21%) and ICU (32%). Sixty-seven percent were ≤ 40 years old, 88% were female, and 73% had ≤ 10 years of work experience. 204 RNs felt that DNR/DNI orders influence treatment choices of physicians, 81% felt they should be more included in the discussion process. Female RNs were more likely to change the amount of time spent at bedside (OR 0.32, 95%CI 0.12-0.92) and they felt that physician's treatment choices were influenced by DNR orders (OR 0.36, 95% CI 0.17-0.74) compared to males. From an RN view, most important factors leading to a DNR/DNI order were patients' wishes (99%), untreated/untreatable cancer (94%) and quality of life before admission (89%). For less experienced RNs, there was a general trend to support the administration of blood products, antibiotics, feeding tube placement, invasive procedures, vasopressors, and ICU transfer. Their support for hemodialysis was the only variable that was statistically significant (OR 1.74, 95% CI 1.03- 2.97). Pooled analysis demonstrated that less experienced were more likely to support a more agressive treatment approach (OR 1.41, 95%CI 1.17-1.71, i^2= 0%).

Conclusion

Nurses regard patients' wishes, quality of life, serious diseases as the most important factors leading to a DNR/DNI order. Less experienced nurses favor a more aggressive treatment approach. Nursing staff feel that they should be a vital part of the DNR/DNI discussion. Further continuous education of the whole health care team on the meaning and implication of DNR/DNI orders is mandated.

Disclosure

All authors have declared no conflicts of interest.