Does Reframing Do Not Resuscitate to Beneficial Care Only Increase Acceptance of No-CPR Orders?

Abstract

Background: The terminology of a do not resuscitate (DNR) order 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 (FC) status and accept a no-CPR order if the order title was BCO?

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. One-half were given a choice between FC and DNR status, and one-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 US participants who were 50% female and 26% non-White (99% response rate, 599 of 600), there was no difference in participant preference for BCO or DNR overall (P = .7616) and across participant sociodemographic characteristics. Although themes of participant reasons for choosing against CPR were similar for both DNR and BCO preferences, including harms imposed by CPR, lack of quality of life, trust in the medical team, and avoidance of suffering, two additional themes appeared only for BCO responses, including CPR would be useless and 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.