Do not attempt resuscitation decisions in a cancer centre: addressing difficult ethical and communication issues

Reid, Colette; Jeffrey, David

doi:10.1038/sj....bjc.6600205...

Cited by 4 publications

(7 citation statements)

References 15 publications

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“…There may be reluctance to consider a DNR discussion unless the physician feels there is no remaining effective therapy to offer [32]. Communication may be impeded by confusion over which team member is responsible for this task, or by the myth that RS should be brought up only in older or more seriously ill patients [10,17]. A commonly held belief is that physicians know their own patients well, and therefore know what they would want.…”

Section: Discussionmentioning

confidence: 99%

“…The notation should attest to the assessment that 'attempts at resuscitation would not [be of] benefit'. The diagnosis, time, date and nature of the discussion with the patient and/or family should be recorded, in addition to the specifics of the agreed-upon RS [17]. If such a discussion was not undertaken, the reasons must be stated in the chart [17].…”

Section: Discussionmentioning

confidence: 99%

“…There is a requirement for a minimum level of documentation in the medical chart accompanying any DNR order [1,17]. The notation should attest to the assessment that 'attempts at resuscitation would not [be of] benefit'.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

In pursuit of an artful death: discussion of resuscitation status on an inpatient radiation oncology service

Fairchild¹,

Kelly²,

Balogh³

2005

Support Care Cancer

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While almost one-third of the patients on this inpatient radiation oncology service had documented DNR status, informed consent appeared to have been obtained in fewer than half. Patient involvement in resuscitative decisions should be an ethical obligation. Performed well, this may also allow for exploration of patients' needs at the end of life, to allow the pursuit of what Nuland terms an 'artful death'.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

In pursuit of an artful death: discussion of resuscitation status on an inpatient radiation oncology service

Fairchild¹,

Kelly²,

Balogh³

2005

Support Care Cancer

View full text Add to dashboard Cite

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“…1 The outcome of CPR in this group of patients is poor 3 and it is considered a futile intervention. 4…”

Section: Introductionmentioning

confidence: 99%

The Relation Between the Timing of Palliative Care and the Frequency and Timing of Do-Not-Resuscitate Orders Among Cancer Deaths in a Tertiary Care Hospital

Alsirafy

Mohammed

Al-Zahrani

et al. 2014

Am J Hosp Palliat Care

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The medical records of 246 in-hospital cancer deaths were reviewed to explore the relation between palliative care (PC) timing and the frequency and timing of do-not-resuscitate (DNR) designation. The rate of DNR designation was 100% in patients referred to PC and 82% in those never referred (P < .001). Patients were grouped into 4 groups: early PC (>90 days from PC referral to death), intermediate PC (>30-90 days), late PC (≤30 days), and no PC. The median DNR to death time was 96, 41, 11, and 3 days, respectively (P < .001). The proportion of intensive care unit (ICU) deaths was 0%, 1%, 3%, and 27%, respectively (P < .001). In conclusion, in a tertiary care hospital, earlier PC was associated with earlier DNR designation and less frequent ICU deaths among in-hospital cancer deaths.

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“…[5][6][7] It has been recommended that the attending physician or another member of the health care team should engage the patients and their caregivers in a timely discussion about advance directives regarding end-of-life care and DNR orders. 4,[8][9][10] Many hospitals and other centers have developed explicit guidelines regarding such discussions. 11,12 It has also been suggested that a truly autonomous decision by a patient regarding DNR orders requires provision of contextual information regarding CPR outcomes among hospitalized patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer

Zafar

Ghafoor

Jamshed

et al. 2016

Am J Hosp Palliat Care

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The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

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Do not attempt resuscitation decisions in a cancer centre: addressing difficult ethical and communication issues

Cited by 4 publications

References 15 publications

In pursuit of an artful death: discussion of resuscitation status on an inpatient radiation oncology service

In pursuit of an artful death: discussion of resuscitation status on an inpatient radiation oncology service

The Relation Between the Timing of Palliative Care and the Frequency and Timing of Do-Not-Resuscitate Orders Among Cancer Deaths in a Tertiary Care Hospital

Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer

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