The addition of a do-not-operate (DNO) section to current medical orders for life-sustaining treatment (MOLST) and physician orders for life-sustaining treatment (POLST) medical order forms would more completely document patients' wishes for invasive interventions at the end of life. We propose a modification of the MOLST and POLST forms, in addition to hospital and electronic medical records, to include a DNO section, in addition to preexisting do-not-resuscitate (DNR) and do-not-intubate (DNI) orders, with the goal of reducing suffering from nonbeneficial surgical interventions in patients with severe illness at the end of life.
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References
1.
CurtisaJR, PatrickDL, CaldwellE, et al.: The quality of patient-doctor communication about end-of-life care: A study of patients with advanced AIDS and their primary care clinicians. AIDS, 1999; 13:1123–1131.
2.
DeteringKM, HancockAD, ReadeMC, et al.: The impact of advance care planning on end-of-life care in elderly patients: Randomised controlled trial. BMJ, 2010; 340:c1345.
3.
LakinJR, IsaacsE, SullivanE, et al.: Emergency physicians' experience with advance care planning documentation in the electronic medical record: useful, needed, and elusive. J Palliat Med, 2016; 19:632–638.
4.
KwokAC, SemelME, LipsitzSR, et al.: The intensity and variation of surgical care at the end-of-life: A retrospective cohort study. Lancet, 2011; 378:1408–1413.
5.
WrightAA, ZhangB, RayA, et al.: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 2008; 300:1665–1673.
6.
CauleyCE, PanizalesMT, ReznorG, et al.: Outcomes after emergency abdominal surgery in patients with advanced cancer: Opportunities to reduce complications and improve palliative care. J Trauma Acute Care Surg, 2015; 79:399–406.
7.
MinerTJ, BrennanMF, JaquesDP: A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer. Ann Surg, 2004; 240:719–726.
8.
MinerTJ, CohenJ, CharpentierK, et al.: The palliative triangle: Improved patient selection and outcomes associated with palliative operations. Arch Surg, 2011; 146:517–522.
9.
CooperZ, CourtwrightA, KarlageA, et al.: Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: Description of the problem and elements of a solution. Ann Surg, 2014; 260:949–957.
10.
TemelJS, GreerJA, GallagherER, et al.: Electronic prompt to improve outpatient code status documentation for patients with advanced lung cancer. J Clin Oncol, 2013; 31:710–715.
