Do not resuscitate: benefits of early decision
Providing information about ‘do not resuscitate’ (DNR) instructions to terminally ill patients leads to fewer of them dying in hospital, a University of Sydney study finds.
“Research consistently shows people prefer to die outside of hospital,” Louise Sharpe, Professor of Clinical Psychology at the University of Sydney says.
“Dying in a non-hospital environment also means savings for our health care system,” Professor Sharpe adds.
The high profile death of terminally ill Sydney woman Aina Ranke in October highlights a case of someone wishing to control their death.
Many people may not choose to completely control their deaths, as Ms Ranke did, but increasing numbers do not want to be revived if they go into cardiopulmonary arrest, a common cause of death for cancer patients.
“Terminally ill patients require resuscitation in the event of cardiopulmonary arrest, unless they have a DNR order,” Professor Sharpe says.
Up to 67% of patients with terminal cancer who were admitted without a DNR order were administered cardiopulmonary rehabilitation (CPR), with less than five per cent surviving the admission.
Late DNR orders often result in increased hospital costs and patients receiving inappropriate life sustaining treatments.
While it is recommended doctors raise the issue with patients early, there is no national policy or standardised information on DNRs. In practice there are wide variations in how early a patient is told about the orders. Few patients in the study had already discussed it with their doctor.
“Our study shows that actively informing patients about their DNR options led to earlier DNR orders being made compared to a control group who were not offered that information,” Professor Sharpe says.
More than 100 Sydney patients with incurable cancer and a prognosis of three to 12 months took part in the study. The intervention regarding DNRs was a discussion with a psychologist and an information pamphlet.
“Importantly, those who were invited to think about the circumstances and given information were not made more anxious or depressed by the intervention. This is consistent with the literature showing that discussion of end of life topics is not harmful to patients.”
