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

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Abstract

Goals of work

Consensus has emerged among health practitioners, legal experts, clinical ethicists and the public that end-of-life decisions should be the shared responsibility of physicians and patients. In discussion of withholding cardiopulmonary resuscitation in cancer patients, however, opinion remains divided. We performed a quality assurance investigation on the use of the ‘do-not-resuscitate’ (DNR) order on an inpatient radiation oncology service to determine how often DNR orders are accompanied by a description of informed consent.

Patients and methods

Records of patients admitted 1 July to 31 December 2002 were identified and reviewed to determine the presence or absence of a DNR order. Circumstances surrounding the order, including evidence of informed consent, were determined.

Main results

The study population comprised 96 patients admitted 109 times. The median age was 64 years, and in 56.0% of admissions, the patient was female. In 26.8%, the patient had lung cancer. The intent of admission was curative in 53.2%, and palliative in 44.0%. DNR was recorded for 30.2% of patients, and there was evidence of informed consent in 41.4%. In 89.7% admission was with palliative intent. Nine patients (9.4%) experienced cardiac arrest; all were DNR at the time of their event.

Conclusions

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’.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cross Cancer Institute, 11560 University Ave., Edmonton, Alberta, Canada, T6G 1Z2

    Alysa Fairchild

  2. Department of Radiation Oncology, Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, Alberta, Canada, T2N 4N2

    Karie-Lynn Kelly & Alex Balogh

Authors
  1. Alysa Fairchild
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  2. Karie-Lynn Kelly
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  3. Alex Balogh
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Correspondence to Alysa Fairchild.

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Fairchild, A., Kelly, KL. & Balogh, A. In pursuit of an artful death: discussion of resuscitation status on an inpatient radiation oncology service. Support Care Cancer 13, 842–849 (2005). https://doi.org/10.1007/s00520-005-0799-2

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  • DOI: https://doi.org/10.1007/s00520-005-0799-2

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