End-of-life care: ‘do not resuscitate’, ‘do not intubate’ and ‘allow natural death’

2018 ◽  
Vol 4 (2) ◽  
pp. 1
Author(s):  
Mahanta Putul
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Natural Death

scholarly journals Race Does Not Influence Do-Not-Resuscitate Status or the Number or Timing of End-of-Life Care Discussions at a Pediatric Oncology Referral Center

2009 ◽  
Vol 12 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Justin N. Baker ◽  
Shesh Rai ◽  
Wei Liu ◽  
Kumar Srivastava ◽  
Javier R. Kane ◽  
...  
Keyword(s):  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Referral Center

scholarly journals Does Death Anxiety Affect End-of-Life Care Discussions?

2014 ◽  
Vol 24 (8) ◽  
pp. 1521-1526 ◽  
Author(s):  
Alaina J. Brown ◽  
Megan J. Shen ◽  
Lois M. Ramondetta ◽  
Diane C. Bodurka ◽  
Robert L. Giuntoli ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death Anxiety ◽  
Linear Regression Analysis ◽  
Gynecologic Oncology ◽  
Family Members ◽  
Comfort Level ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders

ObjectivesThe aim of this study was to determine if a gynecologic cancer patient’s comfort level discussing end-of-life care issues with her caregivers is related to her death anxiety level.Materials/MethodsGynecologic oncology clinic patients were asked to rate their degree of agreeability with 4 statements regarding comfort level discussing end-of-life care issues. Participants also completed the Hoge’s Intrinsic Religiosity Scale and Templer’s Death Anxiety Scale.ResultsFour hundred one surveys were distributed. One hundred twenty-nine patients participated, with a response rate of 32.2%. The median age of the sample was 55 years. Most patients were white (72.9%), married (58.9%), and Christian (85.3%). Most patients had ovarian cancer (40.4%). Of the 74 patients who knew their cancer stage, 59% had been diagnosed with advanced (stage III-IV) disease. Thirty-three percent were currently in remission, and 17% had recurrent disease. Of all patients surveyed, 32.6% were currently receiving treatment. Chemotherapy was the most common treatment (62% of those being treated). Higher level of comfort discussing end-of-life care topics such as do-not-resuscitate orders with family members was significantly associated with decreased death anxiety (P = 0.008 and P = 0.001). There was no significant association between comfort level when patients discussed do-not-resuscitate orders with physicians and patients’ death anxiety (P = 0.14). After controlling for age, race, marital status, education level, current treatment status, and religiosity, linear regression analysis demonstrated that the relationship between a patient’s increased comfort level when discussing end-of-life care topics with family members and decreased death anxiety remained statistically significant (P = 0.005 and P = 0.001).ConclusionsConversations regarding goals of treatment are an important component of caring for cancer patients. Death anxiety may contribute to decreased communication between patients and their family members regarding the patient’s end-of-life care wishes. Obtaining a better understanding of the role death anxiety plays in end-of-life care discussions may help patients receive the end-of-life care they desire.

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

2022 ◽  
pp. 088506662110690
Author(s):  
Daniel King ◽  
Erica Schockett ◽  
Ghazi Rizvi ◽  
Daniel Fischer ◽  
Richard Amdur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Univariate Analysis ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Comfort Care ◽  
Over Time

Objective Dying in the intensive care unit (ICU) has changed over the last twenty years due to increased utilization of palliative care. We sought to examine how palliative medicine (PM) integration into critical care medicine has changed outcomes in end of life including the utilization of do not resuscitate (no cardiopulmonary resuscitation but continue treatment) and comfort care orders (No resuscitation, only comfort medication). Design: Retrospective observational review of critical care patients who died during admission between two decades, 2008 to 09 and 2018 to 19. Setting: Single urban tertiary care academic medical center in Washington, D.C. Patients: Adult patients who were treated in any ICU during the admission which they died. Interventions and Measurements We sought to measure PM involvement across the two decades and its association with end of life care including do not resuscitate (DNR) and comfort care (CC) orders. Main Results: 571 cases were analyzed. Mean age was 65 ± 15, 46% were female. In univariate analysis significantly more patients received PM in 2018 to 19 (40% vs. 27%, p = .002). DNR status increased significantly over time (74% to 84%, p = .002) and was significantly more common in patients who were receiving PM (96% vs. 72%, p < 0.001). CC also increased over time (56% to 70%, p = <0.001), and was more common in PM patients (87% vs. 53%, p < 0.001). Death in the ICU decreased significantly over time (94% to 86%, p = .002) and was significantly lower in PM patients (76% vs. 96%, p < 0.001). The adjusted odds of getting CC for those receiving versus those not receiving PM were 14.51 (5.49-38.36, p < 0.001) in 2008 to 09 versus 3.89 (2.27-6.68, p < 0.001) in 2018 to 19. Conclusion: PM involvement increased significantly across a decade in our ICU and was significantly associated with incidence of DNR and CC orders as well as the decreased incidence of dying in the ICU. The increase in DNR and CC orders independent of PM over the past decade reflect intensivists delivering PM services.

The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation

2008 ◽  
Vol 36 (1) ◽  
pp. 119-140 ◽  
Author(s):  
Susan E. Hickman ◽  
Charles P. Sabatino ◽  
Alvin H. Moss ◽  
Jessica Wehrle Nester
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Treatment Preferences ◽  
Life Care ◽  
Legal Analysis ◽  
Do Not Resuscitate ◽  
Term Care ◽  
Treatment Paradigm ◽  
Life Sustaining Treatment ◽  
Legal Barriers

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR (do not resuscitate) protocols (n = 9 states). Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments (n = 23 states), medical preconditions (n = 15), and witnessing requirements (n = 12) for out-of-hospital DNR protocols.

End-of-Life Care Preferences of Pediatric Patients With Cancer

2005 ◽  
Vol 23 (36) ◽  
pp. 9146-9154 ◽  
Author(s):  
Pamela S. Hinds ◽  
Donna Drew ◽  
Linda L. Oakes ◽  
Maryam Fouladi ◽  
Sheri L. Spunt ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Life Care ◽  
Do Not Resuscitate ◽  
End Of Life Decision ◽  
Life Decision

Purpose The viewpoint of the terminally ill child at the time of an end-of-life decision has not been formally investigated. We identified the preferences of children and adolescents with advanced cancer about their end-of-life care and the factors that influenced their decisions. Patients and Methods Pediatric patients 10 or more years of age were interviewed within 7 days of participating in one of the following three end-of-life decisions: enrollment onto a phase I trial (n = 7), adoption of a do not resuscitate order (n = 5), or initiation of terminal care (n = 8). The patient, a parent, and the primary pediatric oncologist were interviewed separately by using open-ended interview questions. Results Twenty patients, aged 10 to 20 years (mean, 17 years and 4 months), with a refractory solid tumor (n = 12), brain tumor (n = 4), or leukemia (n = 4) participated. Eighteen patients (90%) accurately recalled all of their treatment options and identified their own death as a consequence of their decision. The factors that were most frequently identified included the following: for patients, caring about others (n = 19 patients); for parents, the child's preferences (n = 18 parents); and for physicians, the patient's prognosis and comorbid conditions (n = 14 physicians). Conclusion These children and adolescents with advanced cancer realized that they were involved in an end-of-life decision, understood the consequences of their decision, and were capable of participating in a complex decision process involving risks to themselves and others. The decision factors most frequently reported by patients were relationship based; this finding is contrary to existing developmental theories.

Dementia and Early Do-Not-Resuscitate Orders Associated With Less Intensive of End-of-Life Care: A Retrospective Cohort Study

2021 ◽  
pp. 104990912198902
Author(s):  
Elizabeth A. Luth ◽  
Cynthia X. Pan ◽  
Martin Viola ◽  
Holly G. Prigerson
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Admission ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Dementia Diagnosis ◽  
Do Not Resuscitate Orders

Background: Dementia is a leading cause of death among US older adults. Little is known about end-of-life care intensity and do-not-resuscitate orders (DNRs) among patients with dementia who die in hospital. Aim: Examine the relationship between dementia, DNR timing, and end-of-life care intensity. Design: Observational cohort study. Setting/Participants: Inpatient electronic health record extraction for 2,566 persons age 65 and older who died in 2 New York City hospitals in the United States from 2015 to 2017. Results: Multivariable logistic regression analyses modeled associations between dementia diagnosis, DNR timing, and 6 end-of-life care outcomes. 31% of subjects had a dementia diagnosis; 23% had a DNR on day of hospital admission. Patients with dementia were 18%-40% less likely to have received 4 of 6 types of intensive care (mechanical ventilation AOR: 0.82, 95%CI: 0.67 -1.00; intensive care unit admission AOR: 0.60, 95%CI: 0.49-0.83). Having a DNR on file was inversely associated with staying in the intensive care unit (AOR: 0.57, 95%CI: 0.47-0.70) and avoiding other intensive care measures. DNR placement later during the hospitalization and not having a DNR were associated with more intensive care compared to having a DNR upon admission. Conclusions: Having dementia and a do-not resuscitate order upon hospital admission are associated with less intensive end-of-life care. Additional research is needed to understand why persons with dementia receive less intensive care. In clinical practice, encouraging advance care planning prior to and at hospital admission may be particularly important for patients wishing to avoid intensive end-of-life care, including patients with dementia.

scholarly journals End-of-life care in children and adolescents with cancer: perspectives from a French pediatric oncology care network

2021 ◽  
pp. 030089162110133
Author(s):  
Sophie Blais ◽  
Sarah Cohen-Gogo ◽  
Elodie Gouache ◽  
Lea Guerrini-Rousseau ◽  
Benoit Brethon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Children And Adolescents ◽  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Hematologic Malignancies ◽  
Developed Countries ◽  
Median Number ◽  
Life Care ◽  
Do Not Resuscitate

Background: In developed countries, cancer remains the leading cause of pediatric death from illness after the neonatal period. Objective: To describe the end-of-life care characteristics of children and adolescents with solid tumors (ST) or hematologic malignancies (HM) who died from tumor progression in the Île-de-France area. Methods: This is a regional, multicentric, retrospective review of medical files of all children and adolescents with cancer who died over a 1-year period. Extensive data from the last 3 months of life were collected. Results: A total of 99 eligible patients died at a median age of 9.8 years (range, 0.3–24 years). The most frequent terminal symptoms were pain (n = 86), fatigue (n = 84), dyspnea (n = 49), and anorexia (n = 41). Median number of medications per patient was 8 (range, 3–18). Patients required administration of opioids (n = 91), oxygen (n = 36), and/or sedation (n = 61). Decision for palliative care was present in all medical records and do-not-resuscitate orders in 90/99 cases. Symptom prevalence was comparable between children and adolescents with ST and HM. A wish regarding the place of death had been expressed for 64 patients and could be respected in 42 cases. Death occurred in hospital for 75 patients. Conclusions: This study represents a large and informative cohort illustrating current pediatric palliative care approaches in pediatric oncology. End-of-life remains an active period of care requiring coordination of multiple care teams.

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