The Patient Perspective on Discussion of Perioperative Code Status: A Blind Spot in Efforts to Promote Goal-Concordant Surgical Care.

Abstract

Background: Despite long-standing recognition that providers should discuss DNR (do-not-resuscitate) orders prior to surgery, there is evidence that perioperative code status discussions are frequently of limited quality. Limited attention has been paid to patient perspectives. Objective: Determine the scope of literature on management of perioperative DNR orders from the patient perspective. Design: Systematic search of Embase, OVID, MEDLINE, Web of Science, and CINAHL. Results: We identified over 2700 records, of which only three explored surgical patients' perspectives regarding code status discussions. We highlight themes, analyze limitations of existing evidence, and outline implications for future research. Conclusions: There has been relatively little attention to the patient's perspective, preferences, and expectations regarding perioperative code status decisions. Careful investigation is necessary to inform patient-centerted approaches to communication and decision making regarding perioperative use of life-sustaining therapies.