Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Yujia Ge, B.S. Co-Author: Eliza Klos, B.S. – Miss, Tufts University School of Medicine Co-Author: Tamara Vesel, MD – Dr., Tufts Medical Center Co-Author: Luca Bigatello, MD – Dr., Tufts Medical Center
Introduction: Perioperative do-not-resuscitate (DNR) orders are frequently suspended without comprehensive discussions with patients or clear documentation. This practice undermines patient autonomy and is discouraged by the American Medical Association, American Society of Anesthesiologists, and American College of Surgeons. To address this gap, we are conducting a two-phase project: an informative phase that uses a mixed-methods approach, followed by an interventional phase informed by these findings. We hypothesize the perception of the DNR status diverges among clinicians, between clinicians and institutional policies, and between clinicians and patients. This abstract presents results from a clinician survey assessing knowledge and practices.
Methods: A deidentified survey was distributed to clinicians across departments at Tufts Medical Center from February to June 2025, with collection ongoing. The survey includes demographic items and seven 3-point Likert scale questions. Data were analyzed with R (v2024.04.2+764) using Fisher’s Exact Test for group comparisons.
Results: We have so far received 141 responses from clinicians across five departments: 54 anesthesiologists, 54 surgeons, 21 medical proceduralists, 6 intensive care specialists, and 5 nurses. 79 were staff and 62 were trainees. Temporary suspension of perioperative DNR orders was confirmed as the common approach. 45% of responders were aware that the institution has a DNR policy, and 50% felt that patient and family understanding of DNR status aligned with that of clinicians. Surgeons were more confident in this alignment than anesthesiologists (p < 0.004). Although most respondents reported comfort with leading DNR discussions, confidence was lower among trainees and among non-primary providers. Only 24% would consult services such as Palliative Care or Ethics. 87% expressed interest in further education on this topic. Staff were more familiar with professional society guidelines than trainees (p < 0.003), and anesthesiologists more than surgeons (p < 0.02).
Conclusions: These findings highlight clinicians’ interest in patient-oriented management of DNR orders, a need for educational programming, and the importance of institutional support for initiatives that strengthen shared decision-making in the perioperative setting.
