A communication training perspective on and versus DNR directives Journal Article


Authors: Levin, T. T.; Coyle, N.
Article Title: A communication training perspective on and versus DNR directives
Abstract: Background: From a communication perspective, the term do not resuscitate (DNR) is challenging to use in end-of-life discussions because it omits the goals of care. An alternative, Allow Natural Death (AND), has been proposed as a better way of framing this palliative care discussion. Case: We present a case where a nurse unsuccessfully discusses end-of-life goals of care using the term DNR. Subsequently, with the aid of a communication trainer, he is coached to successfully use the term AND to facilitate this discussion and advance his goal of palliative care communication and planning. Discussion: We contrast the advantages and disadvantages of the term AND from the communication training perspective and suggest that AND-framing language replace DNR as a better way to facilitate meaningful end-of-life communication. One well-designed, randomized, controlled simulation study supports this practice. We also consider the communication implications of natural versus unnatural death. Copyright © Cambridge University Press 2014.
Keywords: end-of-life communication; communication training; advance care directives; allow natural death (and); do not resuscitate (dnr)
Journal Title: Palliative and Supportive Care
Volume: 13
Issue: 2
ISSN: 1478-9515
Publisher: Cambridge University Press  
Date Published: 2015-04-01
Start Page: 385
End Page: 387
Language: English
DOI: 10.1017/s147895151400039x
PROVIDER: scopus
PUBMED: 24774227
DOI/URL:
Notes: Export Date: 3 June 2015 -- Source: Scopus
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MSK Authors
  1. Tomer T Levin
    58 Levin
  2. Nessa M Coyle
    87 Coyle