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

Abstract

<b><i>Background:</i></b> 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. <b><i>Objective:</i></b> Determine the scope of literature on management of perioperative DNR orders from the patient perspective. <b><i>Design:</i></b> Systematic search of Embase, OVID, MEDLINE, Web of Science, and CINAHL. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.