Do-not-resuscitate orders in cancer patients: a review of literature

  title={Do-not-resuscitate orders in cancer patients: a review of literature},
  author={Aart Osinski and Gerard Vreugdenhil and John P. de Koning and Johannes van der Hoeven},
  journal={Supportive Care in Cancer},
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… 
Cardiopulmonary resuscitation in cancer patients: still some problems to solve
The difficulties in estimating the prognosis in cancer patients after cardiopulmonary resuscitation are emphasized, and interprofessional consultation and discussion should always precede do-not-resuscitate orders.
Cardiopulmonary resuscitation in cancer patients: is there a problem?
It is demonstrated that the prognosis of acute kidney injury, related to cast nephropathy, in patients suffering from multiple myeloma (MM), has greatly evolved in recent years and no longer has the same pejorative prognostic value as seen at the end of the twentieth century.
The ethics of DNR-decisions in oncology and hematology care: a qualitative study
DNR-decisions in oncology and hematology care gave rise to ethical considerations and important ethical values described by the participants were to avoid doing harm and to secure a peaceful and “natural” death with dignity for their dying patients.
Do Not Resuscitate Decisions in Cancer Care
This thesis brings together empirical knowledge of DNR decisions in cancer care and theoretical discussions on the ethical aspects and the competence needed to make such decisions from the perspectives of nurses and physicians working in hematology and oncology care.
Cancer patients, physicians, and nurses differ in their attitudes toward the decisional role in do-not-resuscitate decision-making
A substantial discrepancy is found between the attitudes of cancer patients and physicians about the decisional role of patient vs. physician and the timing of the DNR discussion.
Nonstandard do-not-resuscitate orders.
Nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers is discussed.
Evaluating if an Advance Care Planning Intervention Promotes Do-Not-Resuscitate Orders by Facilitating Accurate Prognostic Awareness.
  • F. Wen, C. H. Chen, S. Tang
  • Medicine, Psychology
    Journal of the National Comprehensive Cancer Network : JNCCN
  • 2020
The ACP intervention facilitated the issuance of NDR orders before death among patients with accurate PA, especially those who reported accurate PA 31 to 90 days before death, but it did not facilitate the issuing of DNR orders earlier than their counterparts in the control arm.
Perspectives on the DNR decision process: A survey of nurses and physicians in hematology and oncology
Investigating how important and how likely to happen nurses and physicians considered various aspects of the DNR decision process, regarding participation, information and documentation, as well as which attributes they found most important in relation to DNR decisions found a difference.
The do-not-resuscitate-like (DNRL) order, a medical directive for limiting life-sustaining treatment in the end-of-life care of children with cancer: experience of major cancer center in Brazil
A documented DNRL order was associated with lower odds of dying in the intensive care unit or emergency room, dying within 30 days of endotracheal tube placement, or cardiopulmonary resuscitation (CPR) administration at the time of death (96%).
Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit
This study shows that the presence of an underlying malignancy is independently associated with written TLDs during ICU stay, and whether this higher incidence of T LDs in patients with a malignancies is justified, is at least questionable and should be evaluated in future research.


Practical guidelines for do-not-resuscitate orders.
  • M. Ebell
  • Medicine
    American family physician
  • 1994
To assist patients or their designated surrogate decision-makers, physicians should supply appropriate prognostic information: one-half of all patients survive resuscitation initially, one-third survive for 24 hours and one-eighth survive to leave the hospital.
The influence of do-not-resuscitate orders on care provided for patients in the surgical intensive care unit of a cancer center.
Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea.
From the teaching-hospital-based analysis of terminal cancer patients in Korea, consent for a DNR order was common, however, D NR order forms were not standardized and lacked room to document patient involvement in the decision.
Factors Associated with Do-Not-Resuscitate Orders: Patients' Preferences, Prognoses, and Physicians' Judgments
The role that patients' preferences and other factors related to the patient, physician, and institution had in the incidence and timing of do-not-resuscitate orders is examined.
Discharge patterns, survival outcomes, and changes in clinical management of hospitalized adult patients with cancer with a do-not-resuscitate order.
Most medical interventions were continued with high frequency in adult oncology inpatients after placement of DNR orders, and a majority of patients survived hospitalization and remained alive at 30 days after D NR orders were documented.
Characteristics of patients who refuse do‐not‐resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center
The frequency and predictors of refusals of do‐not‐resuscitate orders in advanced cancer patients admitted to an acute palliative care unit are determined.
Cardiopulmonary Resuscitation in Patients With Cancer
Those factors that affect the outcome of cardiopulmonary resuscitation in patients with cancer are reviewed and recommendations on obtaining do-not-resuscitate orders in these patients are provided.