Do-not-resuscitate orders in cancer patients: a review of literature
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Discussing do-not-resuscitate (DNR) orders is part of daily hospital practice in oncology departments. Several medical factors and patient characteristics are associated with issuing DNR orders in cancer patients. DNR orders are often placed late in the disease process. This may be a cause for disagreements between doctors and between doctors and patients and may cause for unnecessary treatments and admissions. In addition, DNR orders on itself may influence the rest of the medical treatment for patients. We present recommendations for discussing DNR orders and medical futility in practice through shared decision-making. Prospective studies are needed to investigate in which a patient’s cardiopulmonary resuscitation (CPR) is futile and whether or not DNR orders influence the medical care of patients.
KeywordsResuscitation orders Do-not-resuscitate orders Neoplasms Cancer Cardiopulmonary resuscitation Medical futility
All authors made substantial contributions to conception and design of this manuscript. All authors where involved in drafting the manuscript (mainly A. Osinski and G. Vreugdenhil) and revising it critically for important intellectual content. All authors have given final approval of the version to be published. Each author participated sufficiently in the work, to take public responsibility for appropriate portions of the content, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
AO is a resident internal medicine, working at Maxima Medical Centre in Veldhoven, the Netherlands.
GV is an internist-oncologist working at Maxima Medical Centre, in Veldhoven, and Maastricht University Medical Centre, in Maastricht, the Netherlands.
JK is an internist-intensivist working at Maxima Medical Centre in Veldhoven, the Netherlands.
JH is a professor of intensive care medicine at Radboud University Medical Centre in Nijmegen, the Netherlands.
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All data used writing this manuscript van be found in the reference list and are publicly available. No other datasets or materials were used writing this manuscript.
The authors declare that they have no competing interests.
- 3.Hakim RB, Teno JM, Harrell FE Jr, Knaus WA, Wenger N, Phillips RS, Layde P, Califf R, Connors AF Jr, Lynn J (1996) Factors associated with do-not-resuscitate orders: patients’ preferences, prognoses, and physicians’ judgments. SUPPORT InvestigatorsStudy to understand prognoses and preferences for outcomes and risks of treatment. Ann Intern Med 125(4):284–293CrossRefPubMedGoogle Scholar
- 8.Myrianthefs P, Batistaki C, Baltopoulos G (2010) Cardiopulmonary resuscitation in end-stage cancer patients. J BUON: Off J Balkan Union Oncol 15(1):25–28Google Scholar
- 15.Vitelli CE, Cooper K, Rogatko A, Brennan MF (1991) Cardiopulmonary resuscitation and the patient with cancer. J Clin Oncol Off J Am Soc Clin Oncol 9(1):111–115Google Scholar
- 20.Parsons HA, de la Cruz MJ, Zhukovsky DS, Hui D, Delgado-Guay MO, Akitoye AE, El Osta B, Palmer L, Palla SL, Bruera E (2010) Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center. Cancer 116(12):3061–3070. doi: 10.1002/cncr.25045 CrossRefPubMedGoogle Scholar
- 24.Hermans HEGM, Buijsen MAJM (2010) Tweede, geheel herziene druk. Recht & gezondheidszorg. Maarssen: Elsevier Gezondheidszorg. Reed Business, AmsterdamGoogle Scholar
- 26.Rose JH, O’Toole EE, Dawson NV, Lawrence R, Gurley D, Thomas C, Hamel MB, Cohen HJ (2004) Perspectives, preferences, care practices, and outcomes among older and middle-aged patients with late-stage cancer. J Clin Oncol: Off J Am Soc Clin Oncol 22(24):4907–4917. doi: 10.1200/JCO.2004.06.050 CrossRefGoogle Scholar
- 27.Covinsky KE, Fuller JD, Yaffe K, Johnston CB, Hamel MB, Lynn J, Teno JM, Phillips RS (2000) Communication and decision-making in seriously ill patients: findings of the SUPPORT project. The study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc 48(5 Suppl):S187–S193CrossRefPubMedGoogle Scholar
- 28.Wen KY, Lin YC, Cheng JF, Chou PC, Wei CH, Chen YF, Sun JL (2013) Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 21(9):2593–2598. doi: 10.1007/s00520-013-1827-2 CrossRefGoogle Scholar
- 30.Stein RA, Sharpe L, Bell ML, Boyle FM, Dunn SM, Clarke SJ (2013) Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. J Clin Oncol Off J Am Soc Clin Oncol 31(27):3403–3410. doi: 10.1200/JCO.2011.40.8872 CrossRefGoogle Scholar
- 32.Mori M, Ellison D, Ashikaga T, McVeigh U, Ramsay A, Ades S (2013) In-advance end-of-life discussions and the quality of inpatient end-of-life care: a pilot study in bereaved primary caregivers of advanced cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 21(2):629–636. doi: 10.1007/s00520-012-1581-x CrossRefGoogle Scholar
- 33.Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300(14):1665–1673. doi: 10.1001/jama.300.14.1665 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.von Gunten CF (2001) Discussing do-not-resuscitate status. J Clin Oncol Off J Am Soc Clin Oncol 19(5):1576–1581Google Scholar
- 36.Saltbaek L, Michelsen HM, Nelausen KM, Gut R, Nielsen DL (2013) Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 21(12):3363–3370. doi: 10.1007/s00520-013-1916-2 CrossRefGoogle Scholar