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Does reframing do-not-resuscitate to beneficial care only increase acceptance of no-CPR orders?
Article
BACKGROUND: The terminology of a do-not-resuscitate order (DNR) can be confusing and controversial for patients at the end of life. We examined whether changing the name to "Beneficial Care Only" (BCO) would increase patient acceptance.
RESEARCH QUESTION: Would individuals be more willing to forgo full code status and accept a no-CPR order if the order title was "Beneficial Care Only"?
STUDY DESIGN AND METHODS: We conducted a cross-sectional survey of 599 adults residing in the United States, presenting participants with a hypothetical scenario of a terminal patient. Half were given a choice between "full code" (FC) and "DNR" status, and half were given a choice between FC and BCO status. The 20-item survey included multiple-choice responses and one free-response question.
RESULTS: In our nationally representative survey of U.S. participants who were 50% female and 26% nonwhite (99% response rate, n = 599/600), there was no difference in participant preference for BCO or DNR overall (p = 0.7616) and across participant sociodemographic characteristics. While themes of participant reasons for choosing against CPR were similar for both DNR and BCO preferences, including (1) harms imposed by CPR, (2) lack of quality of life, (3) trust in the medical team, (4) avoidance of suffering, two additional themes appeared only for BCO responses: (1) CPR would be useless, and (2) the patient would continue to receive beneficial care.
INTERPRETATION: We found no statistically significant difference in preference between BCO and DNR orders for a terminally ill patient. These findings suggest changing the terminology of DNR to BCO may not lead to changes in decisions to forgo CPR. The additional themes identified with the use of BCO support the concept that BCO terminology conveys to the recipient that all beneficial care will continue to be provided to the patient.
http://dx.doi.org/10.1016/j.chest.2024.08.027
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