Allow natural death versus do-not-resuscitate: titles, information contents, outcomes, and the considerations related to do-not-resuscitate decision

Abstract

BackgroundAs the “do not resuscitate” (DNR) discussion involves communication, this study explored (1) the effects of a title that included “allow natural death”, and of information contents and outcomes of the decision; and (2) the information needs and consideration of the DNR decision, and benefits and barriers of the DNR discussion.MethodsHealthy adults (n = 524) were presented with a scenario with different titles, information contents, and outcomes, and they rated the probability of a DNR decision. A questionnaire including information needs, consideration of the decision, and benefits and barriers of DNR discussion was also used.ResultsThere was a significantly higher probability of signing the DNR order when the title included “allow natural death” (t = − 4.51, p < 0.001), when comprehensive information was provided (F = 60.64, p < 0.001), and when there were worse outcomes (F = 292.16, p < 0.001). Common information needs included remaining life period and the prognosis. Common barriers were the families’ worries and uncertainty about future physical changes.ConclusionThe title, information contents, and outcomes may influence the DNR decisions. Health-care providers should address the concept of natural death, provide comprehensive information, and help patients and families to overcome the barriers.

Can Primary palliative care education change life-sustaining treatment intensity of older adults at the end of life? A retrospective study

“…A study [17] had shown that early DNR consent can reduce the CPR attempt and other invasive treatments in patients with advanced cancer. The patients are more willing to accept a DNR decision when it was referred to as 'allowing natural death', when there is comprehensive information and when there are worse outcomes [19]. Our ndings have implications for further PPC education in geriatrics which focus on CPR appropriateness, skills of prognosis and code status discussion.…”

“…Providing patients and their families with comprehensive information on LST can help to reduce EOL care intensity. A retrospective cross-sectional study [19] from the United States compared the quality of death between patients with end-stage renal disease, cardiopulmonary failure and frailty vs patients with cancer and dementia. The study showed that the former group had reduced quality of death with less palliative care, less DNR and more ICU admission.…”

Exploring health care providers’ perceptions about home-based palliative care in terminally ill cancer patients

“…However, the WHO emphasizes that death should neither be speeded up nor postponed for terminally ill patients, so that they go through the natural process of life and death [4]. Sheng et al mentioned that health staff should have accurate information on the remaining time for the patient, prognosis, symptoms the patient will encounter, outcome and complications of resuscitation, and patient’s wishes, so that they can provide comprehensive information to the family and be able to overcome the barriers to the patient’s natural death [21].…”

A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

“…A study performed in Taiwan showed that the phrasing in the medical record “to allow natural death” versus “do not resuscitate” was perceived as positive and easier to accept when a decision about not attempting CPR was to be taken [26]. Perhaps this phrasing would make it easier for the physician to write the DNACPR-decision in the medical record and this could be a good option in Sweden where the patient has online access to their medical records.…”