DO NOT RESUSCITATE ORDERS IN THE PERIOPERATIVE PERIOD - PATIENT PERSPECTIVES

The purpose of this study was to determine the perspectives and opinio ns of terminally ill patients regarding the management of their do not resuscitate (DNR) orders in the perioperative period. Eighteen patien ts who had DNR orders and were willing to discuss those orders and the ir intentions were identified by hospital nurses or hospice workers. A n in-depth interview was conducted with each patient. Patients' intent ions for DNR orders focused on themes of ''being ready to die'' and co ncern regarding financial and emotional cost to themselves and their f amilies. Fifteen of 18 patients would agree to some type of surgery, s ome to palliative procedures, others to procedures unrelated to their primary disease. After a brief explanation of the different types of a nesthesia and their risks, patients were asked how they would like the ir DNR orders to be respected during the perioperative period. Some wo uld allow procedures in the operating room that ordinarily would be pr ohibited by a DNR order and felt that DNR orders should be suspended. Many felt that their DNR orders should be discussed with them preopera tively. Some wanted to be involved with decisions regarding specific p rocedures. Others were satisfied with discussing the intent of their o rders. For various reasons and for various procedures, many patients w ith DNR orders are willing to undergo anesthesia and surgery. Anesthes iologists' awareness of the variety of opinions and perspectives held by patients regarding their DNR orders will enhance their preoperative discussion.