Residents' practices and perceptions about do not resuscitate orders and pronouncing death: an opportunity for clinical training.

BACKGROUND: Although ''Do not resuscitate'' (DNR) orders are among the most commonly discussed patient preference treatment measures, few studies have assessed internal medicine residents' views on this complex topic. Our objective was to assess resident practices in establishing code status. We also examined resident training and experiences in pronouncing death.
METHODS: An 18-question survey addressing DNR discussions and pronouncing death was emailed to internal medicine residents in the state of Illinois. Each question had multiple-choice options.
RESULTS: A total of 175 residents completed the questionnaire (22% response rate). Seventy-eight percent of the residents had discussed DNR status with patients or their families at least 9 times. However, only one third of the residents felt very comfortable in such discussions. Only 26% of the residents had been observed by a faculty member during a code status discussion and fewer (16%) while pronouncing death. Do not resuscitate discussions rarely occurred in an outpatient clinic (27%). Most residents (90%) thought they would benefit from formal training in DNR discussion.
CONCLUSION: Although most residents discuss DNR status with patients and families, only a quarter are observed in such discussions by attending physicians and only a third feel comfortable with this aspect of clinical care. Developing a structured residency program curriculum to address resident skills in end-of-life care would benefit residency training.