BACKGROUND: Many patients with advanced cancer at our hospital request full resuscitative efforts at the end of life. We assessed the knowledge and attitudes of these patients towards end-of-life (EOL) care, and their preferences about "Do Not Resuscitate" (DNR), "Allow Natural Death" (AND), and "full code" orders. METHODS: The first 100 consenting adult patients with advanced cancer were surveyed regarding their diagnosis, prognosis, and attitudes about critical care and resuscitation. They were then presented with hypothetical scenarios in which a decision on their code status had to be made if they had one year, six months, or one month left to live. Half were given a choice between being "full code" and "DNR," and half could choose between "full code" and "AND." RESULTS: All 93 of the participants who completed the survey were considered by their attending physician to have a terminal illness, but only 42% of these interviewees believed they were terminally ill. In addition, only 25% of participants thought that their primary oncologist knew their EOL wishes. Participants were equally likely to choose either of the "no code" options in all hypothetical scenarios (p>0.54), regardless of age, sex, race, type of cancer, education, or income level. A similar proportion of patients who had a living will chose "AND" and "DNR" orders instead of "full code" in all the scenarios (47%-74% and 63%-71%). In contrast, among patients who did not have a living will, 52% chose "DNR," while 19% opted for "AND." CONCLUSIONS: We hypothesized that "AND" orders may be more acceptable to patients with advanced cancer, but there was no statistically significant difference in acceptability between "AND" and "DNR" orders.
BACKGROUND: Many patients with advanced cancer at our hospital request full resuscitative efforts at the end of life. We assessed the knowledge and attitudes of these patients towards end-of-life (EOL) care, and their preferences about "Do Not Resuscitate" (DNR), "Allow Natural Death" (AND), and "full code" orders. METHODS: The first 100 consenting adult patients with advanced cancer were surveyed regarding their diagnosis, prognosis, and attitudes about critical care and resuscitation. They were then presented with hypothetical scenarios in which a decision on their code status had to be made if they had one year, six months, or one month left to live. Half were given a choice between being "full code" and "DNR," and half could choose between "full code" and "AND." RESULTS: All 93 of the participants who completed the survey were considered by their attending physician to have a terminal illness, but only 42% of these interviewees believed they were terminally ill. In addition, only 25% of participants thought that their primary oncologist knew their EOL wishes. Participants were equally likely to choose either of the "no code" options in all hypothetical scenarios (p>0.54), regardless of age, sex, race, type of cancer, education, or income level. A similar proportion of patients who had a living will chose "AND" and "DNR" orders instead of "full code" in all the scenarios (47%-74% and 63%-71%). In contrast, among patients who did not have a living will, 52% chose "DNR," while 19% opted for "AND." CONCLUSIONS: We hypothesized that "AND" orders may be more acceptable to patients with advanced cancer, but there was no statistically significant difference in acceptability between "AND" and "DNR" orders.
Authors: Angelo E Volandes; Michael K Paasche-Orlow; Susan L Mitchell; Areej El-Jawahri; Aretha Delight Davis; Michael J Barry; Kevan L Hartshorn; Vicki Ann Jackson; Muriel R Gillick; Elizabeth S Walker-Corkery; Yuchiao Chang; Lenny López; Margaret Kemeny; Linda Bulone; Eileen Mann; Sumi Misra; Matt Peachey; Elmer D Abbo; April F Eichler; Andrew S Epstein; Ariela Noy; Tomer T Levin; Jennifer S Temel Journal: J Clin Oncol Date: 2012-12-10 Impact factor: 44.544
Authors: Andrew S Epstein; Angelo E Volandes; Ling Y Chen; Kristen A Gary; Yuelin Li; Patricia Agre; Tomer T Levin; Diane L Reidy; Raymond D Meng; Neil H Segal; Kenneth H Yu; Ghassan K Abou-Alfa; Yelena Y Janjigian; David P Kelsen; Eileen M O'Reilly Journal: J Palliat Med Date: 2013-04-22 Impact factor: 2.947
Authors: Julie C McDonald; Jeanne M du Manoir; Nanor Kevork; Lisa W Le; Camilla Zimmermann Journal: Support Care Cancer Date: 2016-10-07 Impact factor: 3.603
Authors: Keith C Bible; Electron Kebebew; James Brierley; Juan P Brito; Maria E Cabanillas; Thomas J Clark; Antonio Di Cristofano; Robert Foote; Thomas Giordano; Jan Kasperbauer; Kate Newbold; Yuri E Nikiforov; Gregory Randolph; M Sara Rosenthal; Anna M Sawka; Manisha Shah; Ashok Shaha; Robert Smallridge; Carol K Wong-Clark Journal: Thyroid Date: 2021-03 Impact factor: 6.568