ReviewJournal of general internal medicine2011
Hospital do-not-resuscitate orders: why they have failed and how to fix them.
Review in Journal of general internal medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Ceiling of Care in Acute Care Settings: A Concept Analysis.Journal of nursing management · 2026Pooled it
- A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients.Journal of general internal medicine · 2015Trial
- Improving residents' code status discussion skills: a randomized trial.Journal of palliative medicine · 2012Trial
- Operational Ethics in the Cardiovascular Intensive Care Unit: A Practical Framework for Ethical Decision-Making.Journal of clinical medicine · 2026Review
- Article
- Reimagining resuscitation ethics: a narrative review and emergent ethical pathways model.Resuscitation plus · 2026Review
- Awareness, attitudes, and educational needs regarding the life-sustaining treatment decision-making act in Korea among healthcare providers and medical students: a comparative analysis.BMC medical ethics · 2026Article
- The Perspective of the General Population in Saudi Arabia towards Do-Not-Resuscitate (DNR) Orders: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2023Article
- Article
- Palliative Care, Patient-Reported Measures, and Outcomes in Hospitalized Patients With Cirrhosis.Journal of pain and symptom management · 2022Article
- Survey of End-of-Life Care in Intensive Care Units in Ain Shams University Hospitals, Cairo, Egypt.HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2022Article
- Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent.International journal of environmental research and public health · 2021Article
- A descriptive analysis of obstacles to fulfilling the end of life care goals among cardiac arrest patients.Resuscitation plus · 2021Article
- Clinicians' Perspectives After Implementation of the Serious Illness Care Program: A Qualitative Study.JAMA network open · 2021Article
- Low adherence to legislation regarding Do-Not-Attempt-Cardiopulmonary-Resuscitation orders in a Swedish University Hospital.Resuscitation plus · 2021Article
- DNR and COVID-19: The Ethical Dilemma and Suggested Solutions.Frontiers in public health · 2021Review
- The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians.International journal of environmental research and public health · 2020Article
- The ethics of DNR-decisions in oncology and hematology care: a qualitative study.BMC medical ethics · 2020Article
- Are physicians on the same page about do-not-resuscitate? To examine individual physicians' influence on do-not-resuscitate decision-making: a retrospective and observational study.BMC medical ethics · 2019Observational
- Characteristics and Outcomes of Patients with Partial Do Not Resuscitate Orders in a Large Community Hospital.Cureus · 2019Article
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Authors and funding
3 authors.
Funding
Abstract
Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes--to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient self-determination and avoiding non-beneficial interventions at the end of life.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.