Discussions regarding aggressive care with critically ill patients.

Protocols concerning orders not to resuscitate have come into existence recently in order to facilitate decisions regarding resuscitation and to ensure that patient's rights to participate in such decisions are preserved. Prior to the do-not-resuscitate (DNR) decision is the decision whether to discuss the issue of resuscitation with the patient at all. To determine how frequently physicians discuss this issue with their patients, the authors gathered information on all 611 patients admitted to the medical intensive care unit (MICU) or the cardiac care unit (CCU) at a tertiary care teaching hospital over a nine-month period. They found that the issue was discussed with only 10.8% of patients or their families on admission of the patients to these units. Such discussions occurred more frequently with older patients, those who were more severely ill or were estimated to have worse prognoses, those with poor intellectual function, and those admitted to the MICU rather than the CCU.