Awareness of do-not-resuscitate orders: what do patients know and want?

OBJECTIVE: To assess outpatient understanding of and previous experiences with do-not-resuscitate (DNR) orders and to gauge patient preferences with respect to DNR discussions. DESIGN: Cross-sectional, self-administered survey. SETTING: Four urban primary care physician offices in Vancouver, BC. PARTICIPANTS: A total of 429 consecutive patients 40 years of age and older presenting for routine primary care between March and May 2009. MAIN OUTCOME MEASURES: Awareness of, knowledge about, and experiences with DNR decisions; when, where, and with whom patients wished to discuss DNR decisions; and differences in responses by sex, age, and ethnicity, assessed using χ² tests of independence. RESULTS: The response rate was 90%, with 386 of 429 patients completing the surveys. Most (84%) respondents had heard of the terms do not resuscitate or DNR. Eighty-six percent chose family physicians as among the people they most preferred to discuss DNR decisions with; 56% believed that initial DNR discussions should occur while they were healthy; and 46% thought the discussion should take place in the office setting. Of those who were previously aware of DNR orders, 70% had contemplated DNR for their own care, with those older than 60 years more likely to have done so (P = .02); however, only 8% of respondents who were aware of DNR orders had ever discussed the subject with a health care provider. Few patients (16%) found this topic stressful. CONCLUSION: Most respondents were well informed about the meaning of DNR, thought DNR discussions should take place when patients were still healthy, preferred to discuss DNR decisions with family physicians, and did not consider the topic stressful. Yet few respondents reported having had a conversation about DNR decisions with any health care provider. Disparity between patient preferences and experiences suggests that family physicians can and should initiate DNR discussions with younger and healthier patients.

Referee bias contributes to home advantage in English Premiership football.

Officiating bias is thought to contribute to home advantage. Recent research has shown that sports with subjective officiating tend to experience greater home advantage and that referees' decisions can be influenced by crowd noise, but little work has been done to examine whether individual referees vary in their home bias or whether biased decisions contribute to overall home advantage. We develop an ordinal regression model to determine whether various measures of home advantage are affected by the official for the match and by crowd size while controlling for team ability. We examine 5244 English Premier League (EPL) match results involving 50 referees and find that home bias differs between referees. Individual referees give significantly different levels of home advantage, measured as goal differential between the home and away teams, although the significance of this result depends on one referee with a particularly high home advantage (an outlier). Referees vary significantly and robustly in their yellow card and penalty differentials even excluding the outlier. These results confirm that referees are responsible for some of the observed home advantage in the EPL and suggest that home advantage is dependent on the subjective decisions of referees that vary between individuals. We hypothesize that individual referees respond differently to factors such as crowd noise and suggest further research looking at referees' psychological and behavioural responses to biased crowds.