“Do not resuscitate” order and end‐of‐life treatment in a cohort of deceased in a Norwegian University Hospital

Abstract

Background: A "Do not resuscitate" (DNR) order implies that cardiopulmonary resuscitation will not be started. Absent or delayed DNR orders in advanced chronic disease may indicate suboptimal communication about disease stage, prognosis, and treatment goals. The study objective was to determine clinical practice and patient involvement regarding DNR and the prevalence of life-prolonging treatment in the last week of life.Methods: A cross-sectional observational study was made of a cohort of 315 deceased from a large general hospital in Norway. Data on DNR and other treatment limitations, life-prolonging treatment in the last week of life, and cause of death were obtained from medical records.Results: A DNR order was documented for 287 (91%) patients. Almost half the DNR orders, 142 (49%), were made during the last 7 days of life. The main causes of death were cancer (31%), infectious diseases (31%), and cardiovascular diseases (19%). The most frequent life-prolonging treatments during the last week of life were intravenous fluids in 221 patients (70%) and antibiotics in 198 (63%). During the last week of life, 103 (36%) patients received ICU treatment. Death by cancer (odds ratio 2.5, 95% confidence interval 1.24-5.65) and DNR decision made by a palliative care physician (odds ratio 3.4, 95% CI 1.21-3.88) were predictors of not receiving lifeprolonging treatment. Conclusion:The findings of a high prevalence of life-prolonging treatment in the last week of life and DNR orders being made close to the time of death indicate that decisions about limiting life-prolonging treatment are often postponed until the patient's death is imminent."Do not resuscitate" orders, end-of-life care, palliative medicine, treatment limitations

Assessing the impact of palliative care admission of end-of-life cancer adults

“…Our findings correlate with several studies, 22 which have shown that patients who received PC consultation experienced better quality EOL care compared to hospitalized patients or those who did not received prior outpatient PC consultation. This included reduced hospitalizations and costs, increased hospice services, and higher ratings for care and communication by informed family members.…”

“…This phenomenon is not limited to Latin America, as evidenced by a study in Norway that demonstrate a prevalence of treatments in the last weeks of life that prolong life but create unnecessary aggressiveness. 22 Our findings correlate with several studies, 22 which have shown that patients who received PC consultation experienced better quality EOL care compared to hospitalized patients or those who did not received prior outpatient PC consultation. This included reduced hospitalizations and costs, increased hospice services, and higher ratings for care and communication by informed family members.…”

“…This phenomenon is not limited to Latin America, as evidenced by a study in Norway that demonstrate a prevalence of treatments in the last weeks of life that prolong life but create unnecessary aggressiveness. 22…”