We studied the extent to which 82 private physicians and 75 house officers talked with hospitalized patients or their families (or both) about whether they would desire cardiopulmonary resuscitation if it became necessary. During the period of study (1981), 154 patients were resuscitated at our university teaching hospital. In 68 per cent of the cases, physicians had formed an opinion about the patient's attitude toward cardiopulmonary resuscitation. However, only 30 (19 per cent) of the patients had discussed resuscitation before the arrest with either their private physician or a house officer (or both); 51 (33 per cent) of the families were consulted. These percentages did not differ significantly according to the underlying disease, whether the patient was on the general wards or in the intensive-care unit, the physician's estimate of the probability of arrest, or the physician's level of training. Even the 151 physicians who believed that patients should participate in decisions about resuscitation, actually discussed the issue with their patients only rarely. We interviewed the 24 competent patients who survived cardiopulmonary resuscitation, to compare their actual attitudes about resuscitation with their physicians' opinions about their attitudes. The physician's opinion about a patient's desire for resuscitation correlated only weakly with the preference expressed by the patient. We suggest that physicians and patients consider the benefit of open discussion about cardiopulmonary resuscitation.
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Baer, N. A.
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[Full Text]
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[Abstract]
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[Abstract]
SUPPORT Principal Investigators, , Connors, A. F. Jr, Dawson, N. V., Desbiens, N. A., Fulkerson, W. J. Jr, Goldman, L., Knaus, W. A., Lynn, J., Oye, R. K., Knaus, W. A., Lynn, J., Bergner, M., Damiano, A., Hakim, R., Murphy, D. J., Teno, J., Virnig, B., Wagner, D. P., Wu, A. W., Yasui, Y., Robinson, D. K., Kreling, B., Dulac, J., Baker, R., Holayel, S., Meeks, T., Mustafa, M., Vegarra, J., Alzola, C., Harrell, F. E. Jr, Goldman, L., Cook, E. F., Hamel, M. B., Peterson, L., Phillips, R. S., Tsevat, J., Forrow, L., Lesky, L., Davis, R., Kressin, N., Solzan, J., Puopolo, A. L., Barrett, L. Q., Bucko, N., Brown, D., Burns, M., Foskett, C., Hozid, A., Keohane, C., Martinez, C., McWeeney, D., Melia, D., Otto, S., Sheehan, K., Smith, A., Tofias, L., Arthur, B., Collins, C., Cunnion, M., Dyer, D., Kulak, C., Michaels, M., O'Keefe, M., Parker, M., Tuchin, L., Wax, D., Weld, D., Hiltunen, L., Marks, G., Mazzapica, N., Medich, C., Soukup, J., Fulkerson, W. J. Jr, Califf, R. M., Galanos, A. N., Kussin, P., Muhlbaier, L. H., Winchell, M., Mallatratt, L., Akin, E., Belcher, L., Buller, E., Clair, E., Drew, L., Fogelman, L., Frye, D., Fraulo, B., Gessner, D., Hamilton, J., Kruse, K., Landis, D., Nobles, L., Oliverio, R., Wheeler, C., Banks, N., Berry, S., Clayton, M., Hartwell, P., Hubbard, N., Kussin, I., Norman, B., Noveau, J., Read, H., Warren, B., Castle, J., Fraulo, B., Oliverio, R., Turner, K., Perdue, R., Connors, A. F. Jr, Dawson, N. V., Coulton, C., Landefeld, C. S., Speroff, T., Youngner, S., Kennard, M. J., Naccaratto, M., Roach, M. J., Blinkhorn, M., Corrigan, C., Geric, E., Haas, L., Ham, J., Jerdonek, J., Landy, M., Marino, E., Olesen, P., Patzke, S., Repas, L., Schneeberger, K., Smith, C., Tyler, C., Zenczak, M., Anderson, H., Carolin, P., Johnson, C., Leonard, P., Leuenberger, J., Palotta, L., Warren, M., Finley, J., Ross, T., Solem, G., Zronek, S., Davis, S., Desbiens, N. A., Broste, S., Layde, P., Kryda, M., Reding, D. J., Vidaillet, H. J. Jr, Folien, M., Mowery, P., Backus, B. E., Kempf, D. L., Kupfer, J. M., Maassen, K. E., Rohde, J. M., Wilke, N. L., Wilke, S. M., Albee, E. A., Backus, B., Franz, A. M., Henseler, D. L., Herr, J. A., Leick, I., Lezotte, C. L., Meddaugh, L., Duffy, L., Johnson, D., Kronenwetter, S., Merkel, A., Oye, R. K., Bellamy, P. E., Hiatt, J., Wenger, N. S., Leal-Sotelo, M., Moranville-Hawkins, D., Sheehan, P., Watanabe, D., Yamamoto, M. C., Adema, A., Adkins, E., Beckson, A.-M., Carter, M., Duerr, E., El-Hadad, A., Farber, A., Jackson, A., Justice, J., O'Meara, A., Benson, L., Cheney, L., Medina, C., Moriarty, J., Baker, K., Marsden, C., Watne, K., Goya, D., Connors, A. F. Jr, Desbiens, N., Fulkerson, W. J., Harrell, F. E. Jr, Knaus, W. A., Lynn, J., Oye, R. K., Phillips, R. S., Carpenter, C. C. J., Carson, R. A., Detmer, D. E., Steinwachs, D. E., Mor, V., Harootyan, R. A., Leaf, A., Watts, R., Williams, S., Ransohoff, D.
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[Abstract]
Cugliari, A. M., Miller, T., Sobal, J.
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155: 1893-1898
[Abstract]
Fukaura, A., Tazawa, H., Nakajima, H., Adachi, M.
(1995). Do-Not-Resuscitate Orders at a Teaching Hospital in Japan. NEJM
333: 805-808
[Full Text]
Reilly, B. M., Magnussen, C. R., Ross, J., Ash, J., Papa, L., Wagner, M.
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154: 2299-2308
[Abstract]
Markson, L. J., Fanale, J., Steel, K., Kern, D., Annas, G.
(1994). Implementing Advance Directives in the Primary Care Setting. Arch Intern Med
154: 2321-2327
[Abstract]
Virmani, J., Schneiderman, L. J., Kaplan, R. M.
(1994). Relationship of Advance Directives to Physician-Patient Communication. Arch Intern Med
154: 909-913
[Abstract]
O'Toole, E. E., Youngner, S. J., Juknialis, B. W., Daly, B., Bartlett, E. T., Landefeld, C. S.
(1994). Evaluation of a Treatment Limitation Policy With a Specific Treatment-Limiting Order Page. Arch Intern Med
154: 425-432
[Abstract]
Miller, D. L., Gorbien, M. J., Simbartl, L. A., Jahnigen, D. W.
(1993). Factors Influencing Physicians in Recommending In-Hospital Cardiopulmonary Resuscitation. Arch Intern Med
153: 1999-2003
[Abstract]
Murphy, D. J., Finucane, T. E.
(1993). New Do-Not-Resuscitate Policies: A First Step in Cost Control. Arch Intern Med
153: 1641-1648
[Abstract]
Paris, B. E. C., Carrion, V. G., Meditch, J. S. Jr, Capello, C. F., Mulvihill, M. N.
(1993). Roadblocks to Do-Not-Resuscitate Orders: A Study in Policy Implementation. Arch Intern Med
153: 1689-1695
[Abstract]
Haas, J. S., Weissman, J. S., Cleary, P. D., Goldberg, J., Gatsonis, C., Seage, G. R. III, Fowler, F. J. Jr, Massagli, M. P., Makadon, H. J., Epstein, A. M.
(1993). Discussion of Preferences for Life-Sustaining Care by Persons With AIDS: Predictors of Failure in Patient-Physician Communication. Arch Intern Med
153: 1241-1248
[Abstract]
Fried, T. R., Stein, M. D., O'Sullivan, P. S., Brock, D. W., Novack, D. H.
(1993). Limits of Patient Autonomy: Physician Attitudes and Practices Regarding Life-Sustaining Treatments and Euthanasia. Arch Intern Med
153: 722-728
[Abstract]
Brennan, T. A.
(1992). Physicians and Futile Care: Using Ethics Committees to Slow the Momentum. J Law Med Ethics
20: 336-339
Kellogg, F. R., Crain, M., Corwin, J., Brickner, P. W.
(1992). Life-Sustaining Interventions in Frail Elderly Persons: Talking About Choices. Arch Intern Med
152: 2317-2320
[Abstract]
Schneiderman, L. J., Kronick, R., Kaplan, R. M., Anderson, J. P., Langer, R. D.
(1992). Effects of Offering Advance Directives on Medical Treatments and Costs. ANN INTERN MED
117: 599-606
[Abstract]
Brody, B.
(1992). Special Ethical Issues in the Management of PVS Patients. J Law Med Ethics
20: 104-115
Miller, D. L., Jahnigen, D. W., Gorbien, M. J., Simbartl, L.
(1992). Cardiopulmonary Resuscitation: How Useful? Attitudes and Knowledge of an Elderly Population. Arch Intern Med
152: 578-582
[Abstract]
Delbanco, T. L.
(1992). Enriching the Doctor-Patient Relationship by Inviting the Patient's Perspective. ANN INTERN MED
116: 414-418
[Abstract]
Wachter, R. M., Luce, J. M., Hopewell, P. C.
(1992). Critical Care of Patients With AIDS. JAMA
267: 541-547
[Abstract]
Goetzler, R. M., Moskowitz, M. A.
(1991). Changes in Physician Attitudes Toward Limiting Care of Critically Ill Patients. Arch Intern Med
151: 1537-1540
[Abstract]
Seckler, A. B., Meier, D. E., Mulvihill, M., Cammer Paris, B. E.
(1991). Substituted Judgment: How Accurate Are Proxy Predictions?. ANN INTERN MED
115: 92-98
[Abstract]
Tresch, D. D., Sims, F. H., Duthie, E. H., Goldstein, M. D., Lane, P. S.
(1991). Clinical Characteristics of Patients in the Persistent Vegetative State. Arch Intern Med
151: 930-932
[Abstract]
Council on Ethical and Judicial Affairs, American,
(1991). Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders. JAMA
265: 1868-1871
[Abstract]
Uhlmann, R. F., Pearlman, R. A.
(1991). Perceived Quality of Life and Preferences for Life-Sustaining Treatment in Older Adults. Arch Intern Med
151: 495-497
[Abstract]
Gamble, E. R., McDonald, P. J., Lichstein, P. R.
(1991). Knowledge, Attitudes, and Behavior of Elderly Persons Regarding Living Wills. Arch Intern Med
151: 277-280
[Abstract]
Rogers, W. H., Draper, D., Kahn, K. L., Keeler, E. B., Rubenstein, L. V., Kosecoff, J., Brook, R. H.
(1990). Quality of Care Before and After Implementation of the DRG-Based Prospective Payment System: A Summary of Effects. JAMA
264: 1989-1994
[Abstract]
Gleeson, K.
(1990). The Do-Not-Resuscitate Order: Still Too Little Too Late. Arch Intern Med
150: 1057-1060
[Abstract]
Stolman, C. J., Gregory, J. J., Dunn, D., Levine, J. L.
(1990). Evaluation of Patient, Physician, Nurse, and Family Attitudes Toward Do Not Resuscitate Orders. Arch Intern Med
150: 653-658
[Abstract]
Brunetti, L. L., Weiss, M. J., Studenski, S. A., Clipp, E. C.
(1990). Cardiopulmonary Resuscitation Policies and Practices: A Statewide Nursing Home Study. Arch Intern Med
150: 121-126
[Abstract]
Van McCrary, S., Botkin, J. R.
(1989). Hospital Policy on Advance Directives: Do Institutions Ask Patients About Living Wills?. JAMA
262: 2411-2414
[Abstract]
Gates, R. A., Gates, R. H.
(1989). Cardiopulmonary Resuscitation. ANN INTERN MED
111: 686-687
[Abstract]
Wachter, R. M., Luce, J. M., Hearst, N., Lo, B.
(1989). Decisions about Resuscitation: Inequities among Patients with Different Diseases but Similar Prognoses. ANN INTERN MED
111: 525-532
[Abstract]
Stolman, C. J., Gregory, J. J., Dunn, D., Ripley, B.
(1989). Evaluation of the Do Not Resuscitate Orders at a Community Hospital. Arch Intern Med
149: 1851-1856
[Abstract]
Raviglione, M. C., Battan, R., Taranta, A.
(1988). Cardiopulmonary Resuscitation in Patients With the Acquired Immunodeficiency Syndrome: A Prospective Study. Arch Intern Med
148: 2602-2605
[Abstract]
Swinburne, A. J., Fedullo, A. J., Shayne, D. S.
(1988). Mechanical Ventilation: Analysis of Increasing Use and Patient Survival. J Intensive Care Med
3: 315-320
[Abstract]
Murphy, D. J.
(1988). Do-Not-Resuscitate Orders: Time for Reappraisal in Long-term-Care Institutions. JAMA
260: 2098-2101
[Abstract]
La Puma, J., Silverstein, M. D., Stocking, C. B., Roland, D., Siegler, M.
(1988). Life-Sustaining Treatment: A Prospective Study of Patients With DNR Orders in a Teaching Hospital. Arch Intern Med
148: 2193-2198
[Abstract]
Wray, N., Brody, B., Bayer, T., Boisaubin, E., Davila, F., Dresser, R., Dunn, J. K., Engelhardt, H. T. Jr, Haley, H., Hamilton, J. D., Niefield, S., Shelp, E., Scheurich, J.
(1988). Withholding Medical Treatment From the Severely Demented Patient: Decisional Processes and Cost Implications. Arch Intern Med
148: 1980-1984
[Abstract]
Danis, M., Patrick, D. L., Southerland, L. I., Green, M. L.
(1988). Patients' and Families' Preferences for Medical Intensive Care. JAMA
260: 797-802
[Abstract]
Brennan, T. A.
(1988). Ethics Committees and Decisions to Limit Care: The Experience at the Massachusetts General Hospital. JAMA
260: 803-807
[Abstract]
Connelly, J. E., Dalle-Mura, S.
(1988). Ethical Problems in the Medical Office. JAMA
260: 812-815
[Abstract]
Zweibel, N. R.
(1988). Measuring Quality of Life Near the End of Life. JAMA
260: 839-840
[Abstract]
Lawrence, V. A., Clark, G. M.
(1987). Cancer and Resuscitation: Does the Diagnosis Affect the Decision?. Arch Intern Med
147: 1637-1640
[Abstract]
Tabak, E. R.
(1987). The Relationship of Information Exchange During Medical Visits to Patient Satisfaction: A Review. The Diabetes Educator
13: 36-40
Smith, D. G.
(1986). Resuscitation: How Do We Decide?. JAMA
256: 999-999
[Abstract]
Lo, B., McLeod, G. A., Saika, G.
(1986). Patient Attitudes to Discussing Life-Sustaining Treatment. Arch Intern Med
146: 1613-1615
[Abstract]
Bedell, S. E., Pelle, D., Maher, P. L., Cleary, P. D.
(1986). Do-Not-Resuscitate Orders for Critically III Patients in the Hospital: How Are They Used and What Is Their Impact?. JAMA
256: 233-237
[Abstract]
(1986). Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). JAMA
255: 2905-2984
[Abstract]
Charlson, M. E., Sax, F. L., MacKenzie, C. R., Fields, S. D., Braham, R. L., Douglas, R. G. Jr
(1986). Resuscitation: How Do We Decide? A Prospective Study of Physicians' Preferences and the Clinical Course of Hospitalized Patients. JAMA
255: 1316-1322
[Abstract]
Gramelspacher, G. P., Howell, J. D., Young, M. J.
(1986). Perceptions of Ethical Problems by Nurses and Doctors. Arch Intern Med
146: 577-578
[Abstract]
Brennan, T. A.
(1986). Do-Not-Resuscitate Orders for the Incompetent Patient in the Absence of Family Consent. J Law Med Ethics
14: 13-19
Zimmerman, J. E., Knaus, W. A., Sharpe, S. M., Anderson, A. S., Draper, E. A., Wagner, D. P.
(1986). The Use and Implications of Do Not Resuscitate Orders in Intensive Care Units. JAMA
255: 351-356
[Abstract]
Stephens, R. L.
(1986). 'Do Not Resuscitate' Orders: Ensuring the Patient's Participation. JAMA
255: 240-241
[Abstract]
Winkenwerder, W. Jr
(1985). Ethical Dilemmas for House Staff Physicians: The Care of Critically III and Dying Patients. JAMA
254: 3454-3457
[Abstract]
Veatch, R. M.
(1985). Doctor's Orders. JAMA
254: 3468-3468
[Abstract]
Evans, A. L., Brody, B. A.
(1985). The Do-Not-Resuscitate Order in Teaching Hospitals. JAMA
253: 2236-2239
[Abstract]
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