How do-not-resuscitate orders are utilized in cancer patients: Timing relative to death and communication-training implications Journal Article
| Authors: | Levin, T. T.; Li, Y.; Weiner, J. S.; Lewis, F. B. S.; Bartell, A.; Piercy, J.; Kissane, D. W. |
| Article Title: | How do-not-resuscitate orders are utilized in cancer patients: Timing relative to death and communication-training implications |
| Abstract: | Objectives: End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs). Despite this, there is little DNR utilization data to guide the design of communication-training programs. The objective of this study was to determine DNR utilization patterns and whether their use is increasing. Methods: A retrospective database analysis (2000-2005) of DNR data for 206,437 patients, the entire patient population at Memorial Sloan-Kettering Cancer Center (MSKCC), was performed. Results: The hospital recorded, on average, 4,167 deaths/year. In 2005, 86% of inpatient deaths had a DNR, a 3% increase since 2000 (p < .01). For patients who died outside the institution (e.g., hospice), 52% had a DNR, a 24% increase over 6 years (p < .00001). Adult inpatients signed 53% of DNRs but 34% were signed by surrogates. The median time between signing and death was 0 days, that is, the day of death. Only 5.5% of inpatient deaths had previously signed an outpatient DNR. Here, the median time between signing and death was 30 days. Significance of results: Although DNR directives are commonly utilized and their use has increased significantly over the past 6 years, most cancer patients/surrogates sign the directives on the day of death. The proximity between signing and death may be a marker of delayed end-of-life palliative care and suboptimal doctor - patient communication. These data underscore the importance of communication-training research tailored to improve end-of-life decision making. © 2008 Cambridge University Press. |
| Keywords: | aged; aged, 80 and over; middle aged; retrospective studies; united states; palliative care; statistics; terminally ill patient; retrospective study; patient participation; psychological aspect; social support; terminally ill; communication; hospital patient; interpersonal communication; decision making; human relation; professional-family relations; hospice; resuscitation; attitude to death; resuscitation orders; death and dying; advance directives; inpatients; custody; living will; proxy; communication training; do-not-resuscitate orders; hospices |
| Journal Title: | Palliative and Supportive Care |
| Volume: | 6 |
| Issue: | 4 |
| ISSN: | 1478-9515 |
| Publisher: | Cambridge University Press |
| Date Published: | 2008-01-01 |
| Start Page: | 341 |
| End Page: | 348 |
| Language: | English |
| DOI: | 10.1017/s1478951508000540 |
| PUBMED: | 19006588 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 10" - "Export Date: 17 November 2011" - "Source: Scopus" |
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