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Supportive Care in Cancer
Published in: Supportive Care in Cancer 12/2020

01-12-2020 | Cardiopulmonary Resuscitation | Original Article

Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making

Authors: Lena Saltbæk, Hanne M. Michelsen, Knud M. Nelausen, Susann Theile, Christian Dehlendorff, Susanne O. Dalton, Dorte L. Nielsen

Published in: Supportive Care in Cancer | Issue 12/2020

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Abstract

Purpose

Do-not-resuscitate (DNR) decision-making in severely ill patients presents many difficult medical, ethical, and legal challenges. The primary aim of this study was to explore cancer patients’ and health care professionals’ attitudes regarding DNR decision-making authority and timing of the decision.

Methods

This study was a questionnaire survey among Danish cancer patients and their attending physicians and nurses in an oncology outpatient setting. Potential differences between patients’, physicians’, and nurses’ answers to the questionnaire were analyzed using Fisher’s exact test.

Results

Responses from 904 patients, 59 physicians, and 160 nurses were analyzed. The majority in all three groups agreed that DNR decisions should be made in collaboration between physician and patient. However, one-third of the patients answered that the patient alone should make the decision regarding DNR, which contrasts with the physicians’ and nurses’ attitudes, 0% and 6% pointing to the patient as sole decision-maker, respectively. In case of disagreement between patient and physician, a majority of both patients (66%) and physicians (86%) suggested themselves as the ultimate decision-maker. Additionally, 43% of patients but only 19% of physicians preferred the DNR discussion being brought up early in the course of the disease.

Conclusions

With regard to the decisional role of patient vs. physician and the timing of the DNR discussion, we found a substantial discrepancy between the attitudes of cancer patients and physicians. This discrepancy calls for a greater awareness and discussion of this sensitive topic among both health care professionals and the public.
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Literature
1.
Osinski A, Vreugdenhil G, de Koning J, van der Hoeven JG (2017) Do-not-resuscitate orders in cancer patients: a review of literature. Support Care Cancer 25:677–685CrossRef
2.
Voogt E, van der Heide A, Rietjens JA et al (2005) Attitudes of patients with incurable cancer toward medical treatment in the last phase of life. J Clin Oncol 23:2012–2019CrossRef
3.
Ministry of Health. Danish Health Act, Act no. 191. Chapter 5, § 15, 16, 21, chapter 6, § 25, 26. In. 2018
4.
Ministry of Health. Vejledning om forudgående fravalg af livsforlængende behandling, herunder genoplivningsforsøg, og om afbrydelse af behandling. VEJ nr 9374. In. 2018
5.
Decisions relating to cardiopulmonary resuscitation. Guidance from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. 3rd edition. In. 2016
6.
Moselli NM, Debernardi F, Piovano F (2006) Forgoing life sustaining treatments: differences and similarities between North America and Europe. Acta Anaesthesiol Scand 50:1177–1186CrossRef
7.
Levorato A, Stiefel F, Mazzocato C, Bruera E (2001) Communication with terminal cancer patients in palliative care: are there differences between nurses and physicians? Support Care Cancer 9:420–427CrossRef
8.
Saltbaek L, Tvedegaard E (2012) Decision to resuscitate or not in patients with chronic diseases. Dan Med J 59:A4353PubMed
9.
Eliott JA, Olver I (2011) Dying cancer patients talk about physician and patient roles in DNR decision making. Health Expect 14:147–158CrossRef
10.
Brown VA, Parker PA, Furber L, Thomas AL (2011) Patient preferences for the delivery of bad news - the experience of a UK Cancer Centre. Eur J Cancer Care (Engl) 20:56–61CrossRef
11.
Heyland DK, Frank C, Groll D, Pichora D, Dodek P, Rocker G, Gafni A (2006) Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members. Chest 130:419–428CrossRef
12.
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 21:3363–3370CrossRef
13.
A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. In. 2017
14.
Varon J, Walsh GL, Marik PE, Fromm RE (1998) Should a cancer patient be resuscitated following an in-hospital cardiac arrest? Resuscitation 36:165–168CrossRef
15.
Ewer MS, Kish SK, Martin CG, Price KJ, Feeley TW (2001) Characteristics of cardiac arrest in cancer patients as a predictor of survival after cardiopulmonary resuscitation. Cancer 92:1905–1912CrossRef
16.
Mack JW, Cronin A, Taback N, Huskamp HA, Keating NL, Malin JL, Earle CC, Weeks JC (2012) End-of-life care discussions among patients with advanced cancer: a cohort study. Ann Intern Med 156:204–210CrossRef
17.
Sharma RK, Dy SM (2011) Documentation of information and care planning for patients with advanced cancer: associations with patient characteristics and utilization of hospital care. Am J Hosp Palliat Care 28:543–549CrossRef
18.
Ermers DJM, van Bussel KJH, Perry M, Engels Y, Schers HJ (2019) Advance care planning for patients with cancer in the palliative phase in Dutch general practices. Fam Pract 36:587–593CrossRef
19.
Olver I, Eliott JA (2008) The perceptions of do-not-resuscitate policies of dying patients with cancer. Psychooncology 17:347–353CrossRef
20.
Cox K, Wilson E, Jones L, Fyfe D (2007) An exploratory, interview study of oncology patients’ and health-care staff experiences of discussing resuscitation. Psychooncology 16:985–993CrossRef
21.
Zwakman M, Jabbarian LJ, van Delden J, van der Heide A, Korfage IJ, Pollock K, Rietjens J, Seymour J, Kars MC (2018) Advance care planning: a systematic review about experiences of patients with a life-threatening or life-limiting illness. Palliat Med 32:1305–1321CrossRef
22.
Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S (2001) Patient preferences versus physician perceptions of treatment decisions in cancer care. J Clin Oncol 19:2883–2885CrossRef
23.
Barnato AE, Hsu HE, Bryce CL, Lave JR, Emlet LL, Angus DC, Arnold RM (2008) Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study. Crit Care Med 36:3156–3163CrossRef
24.
O'Brien JM Jr, Aberegg SK, Ali NA et al (2009) Results from the national sepsis practice survey: predictions about mortality and morbidity and recommendations for limitation of care orders. Crit Care 13:R96CrossRef
25.
Becerra M, Hurst SA, Junod Perron N, Cochet S, Elger BS (2011) ‘Do not attempt resuscitation’ and ‘cardiopulmonary resuscitation’ in an inpatient setting: factors influencing physicians’ decisions in Switzerland. Gerontology 57:414–421PubMed
26.
Junod Perron N, Morabia A, de Torrente A (2002) Quality of life of do-not-resuscitate (DNR) patients: how good are physicians in assessing DNR patients’ quality of life? Swiss Med Wkly 132:562–565PubMed
Metadata
Title
Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making
Authors
Lena Saltbæk
Hanne M. Michelsen
Knud M. Nelausen
Susann Theile
Christian Dehlendorff
Susanne O. Dalton
Dorte L. Nielsen
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 12/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-020-05460-7

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