Provider and Patient Gender Influence on Timing of Do-Not-Resuscitate Orders in Hospitalized Patients with Cancer

2016 ◽  
Vol 19 (7) ◽  
pp. 728-733 ◽  
Author(s):  
Melissa A. Crosby ◽  
Lee Cheng ◽  
Alma Y. DeJesus ◽  
Elizabeth L. Travis ◽  
Maria A. Rodriguez
Keyword(s):  
Hospitalized Patients ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Gender Influence ◽  
Patient Gender ◽  
Do Not Resuscitate Orders

Provider and patient gender influence on timing of do-not-resuscitate in hospitalized patients with cancer.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e20500-e20500
Author(s):  
Melissa Crosby ◽  
Lee Cheng ◽  
Alma Yvette DeJesus ◽  
Maria Alma Rodriguez
Keyword(s):  
Hospitalized Patients ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Gender Influence ◽  
Patient Gender

scholarly journals "Do-not-resuscitate" orders in patients with cancer at a children's hospital in Taiwan

2007 ◽  
Vol 33 (4) ◽  
pp. 194-196 ◽  
Author(s):  
T.-H. Jaing ◽  
P.-K. Tsay ◽  
E.-C. Fang ◽  
S.-H. Yang ◽  
S.-H. Chen ◽  
...  
Keyword(s):  
Do Not Resuscitate ◽  
Children's Hospital ◽  
Patients With Cancer ◽  
Children’S Hospital ◽  
Do Not Resuscitate Orders

Different Associations Between Inpatient or Outpatient Palliative Care and End-of-Life Outcomes for Hospitalized Patients With Cancer

2021 ◽  
Author(s):  
Jonathan C. Yeh ◽  
Arielle R. Urman ◽  
Robert J. Besaw ◽  
Laura E. Dodge ◽  
Kathleen A. Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Care Planning ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Advance Care

PURPOSE Palliative care (PC) improves outcomes in advanced cancer, and guidelines recommend early outpatient referral. However, many PC teams see more inpatient than outpatient consults. We conducted a retrospective study of hospitalized patients with cancer to quantify exposure to inpatient and outpatient PC and describe associations between PC and end-of-life (EOL) quality measures. METHODS We identified all decedents admitted to an inpatient oncology unit in 1 year (October 1, 2017-September 30, 2018) and abstracted hospitalization statistics, inpatient and outpatient PC visits, and EOL outcomes. Descriptive statistics, univariate tests, and multivariate analysis evaluated associations between PC and patient outcomes. RESULTS In total, 522 decedents were identified. 50% saw PC; only 21% had an outpatient PC visit. Decedents seen by PC were more likely to enroll in hospice (78% v 44%; P < .001), have do-not-resuscitate status (87% v 55%; P < .001), have advance care planning documents (53% v 31%; P < .001), and die at home or inpatient hospice instead of in hospital (67% v 40%; P < .01). Decedents seen by PC had longer hospital length-of-stay (LOS; 8.4 v 7.0 days; P = .03), but this association reversed for decedents seen by outpatient PC (6.3 v 8.3 days; P < .001), who also had longer hospice LOS (46.5 v 27.1 days; P < .01) and less EOL intensive care (6% v 15%; P < .05). CONCLUSION PC was associated with significantly more hospice utilization and advance care planning. Patients seen specifically by outpatient PC had shorter hospital LOS and longer hospice LOS. These findings suggest different effects of inpatient and outpatient PC, underscoring the importance of robust outpatient PC.

Do-Not-Resuscitate Orders for Terminal Patients with Cancer in Teaching Hospitals of Korea

2007 ◽  
Vol 10 (5) ◽  
pp. 1153-1158 ◽  
Author(s):  
Do Yeun Kim ◽  
Kyoung Eun Lee ◽  
Eun Mi Nam ◽  
Hye Ran Lee ◽  
Keun-Wook Lee ◽  
...  
Keyword(s):  
Teaching Hospitals ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Do Not Resuscitate Orders

scholarly journals Impact of Palliative Medicine Involvement on End-of-Life Services for Patients With Cancer With In-Hospital Deaths

2017 ◽  
Vol 13 (9) ◽  
pp. e749-e759 ◽  
Author(s):  
Alison Wiesenthal ◽  
Debra A. Goldman ◽  
Deborah Korenstein
Keyword(s):  
End Of Life ◽  
Solid Tumor ◽  
Diagnostic Testing ◽  
Cancer Center ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Dying Patients ◽  
Hospital Deaths ◽  
Do Not Resuscitate Orders

Purpose: Palliative care (PC) has been shown to improve the quality of care and resource utilization for inpatients. We examined the relationship between PC consultation before and during final admission and patterns of care for dying patients at our tertiary cancer center. Methods: We retrospectively reviewed adult patients with solid tumor cancer with a length of stay ≥ 3 days who died in hospital between December 2012 and November 2014. We recorded services, including laboratory testing, imaging, blood products, medications, diet orders, do not resuscitate orders, and consultations, delivered within 3 days of death. We assessed the differences among services delivered to patients with outpatient PC, inpatient PC only, and no PC involvement. Results: Of 695 patients, 21% received outpatient PC, 46% received inpatient PC only, and 33% received no PC. During their final admission, 11.2% of patients received radiation therapy, and 12.5% received tumor-directed therapy, with no differences on the basis PC involvement ( P = .09 to .17). In the last 3 days of life, imaging tests occurred in 50.1%; patients with outpatient or inpatient-only PC underwent fewer studies (43.5% and 47.3%) than did those with no PC involvement (58.1%; P = .048). Do not resuscitate orders were in place within the 6 months before final admission at a greater rate for patients with outpatient PC (22%) than for patients with inpatient-only PC (8%) or those with no PC involvement (12%; P = .002). Conclusion: In this retrospective cohort of patients with solid tumor dying in hospital, few patients received cancer-directed therapies at the end of life. Involvement of PC was associated with a decrease in diagnostic testing and other services not clearly promoting comfort as patients approached death.

Legitimating Do-not-Resuscitate Orders: A Discursive Study of Cancer Patients’ Speech

2003 ◽  
Vol 19 (2) ◽  
pp. 100-106 ◽  
Author(s):  
Jaklin A. Eliott ◽  
Ian N. Olver
Keyword(s):  
Cancer Patients ◽  
Combined Effect ◽  
Western Society ◽  
Do Not Resuscitate ◽  
Structured Interviews ◽  
Patients With Cancer ◽  
Natural Event ◽  
Do Not Resuscitate Orders ◽  
The Individual ◽  
Dnr Orders

This article examines how patients with cancer construct and legitimate do-not-resuscitate (DNR) orders. Semi-structured interviews with 23 outpatients attending an oncology clinic were tape-recorded, transcribed, and analyzed in accordance with discourse-analytic methodology. Results indicate some variability for participants regarding the meaning of DNR orders, which were nonetheless viewed as appropriate and desirable. The patient's subsequent death was legitimated primarily through the invocation of highly valorized discourses within Western society: nature, autonomy, and compassion. Non-compliance with DNR orders, or the instigation of CPR was seen as violating nature, infringing autonomy, and as uncompassionate. The combined effect was to construct dying as a natural event which is the concern of the individual patient and their family, endorsing medical non-intervention in the process. This research provides support, from the patients’ viewpoint, for a policy of non-intervention when death is imminent and inevitable, and for those questioning the wisdom of a default policy of initiating CPR on any hospitalized patient, especially those patients inevitably in the process of dying.

Differential impact of inpatient and outpatient palliative care on end-of-life outcomes in hospitalized patients with cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 24-24
Author(s):  
Arielle R. Urman ◽  
Mary K. Buss ◽  
Robert J. Besaw ◽  
Laura E. Dodge ◽  
Kathleen A. Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Statistical Tests ◽  
Quality Measures ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Fiscal Year ◽  
Do Not Resuscitate ◽  
Patients With Cancer

24 Background: Palliative care (PC) improves outcomes for patients with advanced cancer, and current ASCO guidelines recommend early outpatient referral. However, recent data show that PC teams at many cancer centers see more inpatient consults than outpatient visits; the comparative impact of inpatient versus outpatient PC is not well-described. For this reason, we conducted a retrospective cohort study of hospitalized cancer patients to quantify exposure to inpatient/outpatient PC, and to describe associations between PC exposure and end-of-life (EOL) quality measures including hospice utilization, advance care planning (ACP), and intensity of care. Methods: We identified all patients admitted to one cancer center’s inpatient oncology unit during one fiscal year (10/1/2017-9/30/2018). Demographics, admission statistics, inpatient/outpatient PC visits, and EOL outcomes were abstracted from the electronic medical record. Decedents were identified through chart review and public obituaries. Results were summarized by descriptive statistics, and standard statistical tests were used to evaluate associations between PC exposure and EOL outcomes. Results: 842 patients were hospitalized in one year. 522 patients died by the study end-date of 10/1/2020 and were included in analysis. 50% of decedents had any PC exposure prior to death, but only 21% had an outpatient PC visit. Patients seen by PC were younger at time of death, (median: 67 vs 72 years; p <.001) and more likely to be female (52% vs 42%; p =.03). Compared to patients never seen by PC, patients with any PC exposure were significantly more likely to enroll in hospice (78% vs 44%; p <.0001), have do-not-resuscitate status (87% vs 55%; p <.0001), have scanned ACP documents (53% vs 31%; p <.0001), and die at home or inpatient hospice instead of in the hospital (67% vs 40%; p <.01). PC exposure was not associated with differences in 30-day re-admissions, systemic cancer therapy in the last 14 days of life, or intensive care (ICU) utilization in the last 30 days of life. Notably, PC exposure was associated with longer hospital length-of-stay (LOS) (8.4 vs 7.2 days), but this association was reversed for patients seen by outpatient PC versus all others (6.3 vs 8.2 days; p <.01). Patients seen by outpatient PC also had longer hospice LOS (46.5 vs 27.1 days; p <.01) and less EOL ICU use (6% vs 15%; p <.05) compared to all others. Conclusions: In this large retrospective study of hospitalized patients with cancer, PC exposure was associated with significant improvements in multiple EOL quality measures. The subset of patients seen by outpatient PC experienced additional benefits, including shorter hospital LOS, longer hospice LOS, and less EOL ICU utilization. These findings point to differential effects between inpatient and outpatient PC, underscoring the importance of early, longitudinal PC involvement.

scholarly journals “DO NOT RESUSCITATE” ORDERS AMONG HOSPITALIZED PATIENTS WITH COVID-19: EVALUATING PREVENTIVE ETHICS REGARDING CARDIOPULMONARY RESUSCITATION

2021 ◽  
Vol 7 ◽  
pp. 100271
Author(s):  
Johnathan Kirupakaran ◽  
Dhiviyan Valentine ◽  
Aye Mon Thida ◽  
Paula Bianca Rodriguez ◽  
Giovanna Rodriguez ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Hospitalized Patients ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders ◽  
Preventive Ethics
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