Background and Aims
This study aims to assess current practices and perspectives of gastroenterologists
on approaches to code status before inpatient endoscopy.
Methods
Self-reported data were obtained through a voluntary, anonymous survey of gastroenterologists
and gastroenterology trainees in the United States. The survey assessed respondents’
approach to, beliefs, and knowledge regarding inpatient periprocedural code status
discussions.
Results
Four hundred thirty-six gastroenterologists and 83 trainees completed the survey.
For patients with an existing do not resuscitate (DNR) order, respondents reversed
the code status before endoscopy either all (40.8%, n = 212) or most of the time (18.3%,
n = 95). When asked their personal opinion, 32.6% (n =169) supported automatic DNR
reversal to full resuscitation attempt during a procedure, 18.5% (n = 96) supported
that DNR orders could be sustained, and 48.7% (n = 253) supported offering limited
resuscitation. Many gastroenterologists were unaware of institutional (40.7%, n =
211) or national (80.7%, n = 419) policies, and a majority reported that a gastroenterology-specific
guideline would be helpful (88.6%, n = 460).
Conclusions
Although most of the gastroenterologists reverse DNR orders more than 75% of the time
before endoscopy, many also believe patients should be allowed to remain DNR during
a procedure and supported a third option for limited resuscitation. Most gastroenterologists
were unaware of institutional policies or existing national guidelines. These findings
suggest considerable variation in knowledge and current approaches regarding periendoscopic
code status reversal.
Graphical abstract
Graphical Abstract
Abbreviation:
DNR (do not resuscitate)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit.Gastroenterol Rep. 2020; 8: 299-305
- Strategies for collaborative consideration of patients' resuscitation preferences.AMA J Ethics. 2020; 22: E325-E332
- Discussion of code status in the peri-endoscopic period.Am J Gastroenterol. 2019; 114: 372-374
- Ethical guidelines for the anesthesia care of patients with do-not-resuscitate orders or other directives that limit treatment. American Society of Anesthesiologists.(Available at:) (Accessed May 1, 2019)
- Revisiting code status in patients undergoing GI endoscopy with a "do not resuscitate" order.Gastrointest Endosc. 2019; 89: 380-382
- Code status reversal for do-not-resuscitate patients undergoing invasive procedures: current practices and beliefs of medical and surgical residents.J Palliat Med. 2019; 22: 1024-1025
- Physician gender effects in medical communication: a meta-analytic review.JAMA. 2002; 288: 756-764
- Addressing gender in gastroenterology: opportunities for change.Gastrointest Endosc. 2020; 91: 155-161
- Gastroenterology training and career choices: a prospective longitudinal study of the impact of gender and of managed care.Am J Gastroenterol. 2002; 97: 459-469
- Response rates of medical providers to internet surveys regarding their adoption of preexposure prophylaxis for HIV: methodological implications.J Int Assoc Provid AIDS Care. 2018; 172325958218798373
- Enhancing response rates in physician surveys: the limited utility of electronic options.Health Serv Res. 2011; 46: 1675-1682
Article info
Publication history
Published online: January 18, 2021
Accepted:
January 8,
2021
Received:
August 14,
2020
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
