Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center.

Title

Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center.

Creator

Parsons HA; de la Cruz MJ; Zhukovsky DS; Hui D; Delgado-Guay MO; Akitoye AE; El Osta B; Palmer JL; Palla SL; Bruera E

Identifier

Publisher

Cancer

Date

2010

Subject

Female; Humans; Male; Palliative Care; Adult; Middle Aged; Patient Acceptance of Health Care; Survival Analysis; Case-Control Studies; African Americans; retrospective studies; DNAR; Cancer Care Facilities; Neoplasms/di [Diagnosis]; Neoplasms/mo [Mortality]; Resuscitation Orders; Nausea/co [Complications]; Pain/co [Complications]

Description

BACKGROUND: Refusal of appropriately indicated do-not-resuscitate (DNR) orders may cause harm and distress for patients, families, and the medical team. We conducted a retrospective study to determine the frequency and predictors of refusals of DNR in advanced cancer patients admitted to an acute palliative care unit., METHODS: A total of 2538 consecutive admissions were reviewed. Demographic and clinical characteristics from 200 consecutive patients with DNR orders and 100 consecutive patients who refused DNR were collected, and differences between the groups were determined by multivariate regression and recursive partitioning analysis., RESULTS: Of 2538 admissions, 2530 (99%) were appropriate for DNR discussion. Of the 2530 admissions, 2374 were unique patients, and 100 (4%) of 2374 refused DNR. Refusers had median (interquartile range, IQR) pain of 7 (4-9) versus 5 (3-8, P = .0005), nausea of 2 (0-7) versus 1 (0-4, P = .05), and dyspnea of 1 (0-5) versus 4 (0-7, P = .002) as compared with DNR nonrefusers, respectively. Patients with hematological malignancies and advance directives had a lower DNR refusal risk (odds ratio [OR], 0.38; P = .02, and OR, 0.36; P < .0001, respectively). Multivariate regression analysis revealed that patients with moderate-severe pain (OR, 3.19; P = .002) and with no advance directives (OR, 2.94; P < or = .001) had higher DNR refusal risk. There were more inpatient deaths among DNR nonrefusers (87 of 200 vs 1 of 100, P < .0001). Median (IQR) time from discharge to death was 18 (8-35) days for those with DNR orders and 85 (25-206) days for DNR refusers (P < or = .0001)., CONCLUSIONS: DNR refusal in patients admitted to the acute palliative care unit is low, more frequent in patients with more pain and nausea and no advance directives, and associated with longer survival. This study demonstrates possible predictors of complicated DNR discussions.
2010

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

3061-70

Issue

12

Volume

116

Citation

Parsons HA; de la Cruz MJ; Zhukovsky DS; Hui D; Delgado-Guay MO; Akitoye AE; El Osta B; Palmer JL; Palla SL; Bruera E, “Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center.,” Pediatric Palliative Care Library, accessed January 19, 2022, https://pedpalascnetlibrary.omeka.net/items/show/14457.

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