Abstract
Background: Do Not Resuscitate (DNR) is a significant but challenging part of end-of-life discussions when dealing with incurable lung cancer patients. We have explored the perceptions and preferences of patients, their caregivers (CGs), and health care providers (HCPs) and the current practice and opinions on DNR discussions in a multidisciplinary lung cancer clinic.Materials and Methods: This is a prospective descriptive study with a mixed quantitative and qualitative methodology to capture perceptions of the participants. To obtain a rich description of participant responses to questionnaire items, we employed a ‘think aloud’ process that prompted participants to immediately verbalize their thoughts when responding to questionnaire items. We used content analysis and constant comparison techniques to identify, code and categorize primary themes in the captured data.Results: Ten patients with advanced-stage lung cancer; nine CGs from the lung clinic and ten HCPs from the Thoracic Disease Site Group (DSG) were enrolled in the study. Most patients had only a limited understanding of DNR. Most CGs had a fair to good understanding of DNR. Most HCPs perceived their patients to have understood DNR most of the time. When patients were interviewed, a theme of “anticipated discussion” about DNR was identified. Patients and CGs expressed having faith in the system and responsible physicians as to when to discuss DNR. HCPs embraced a clinician preference-based decision-making approach to engaging in DNR discussions. They desired more resources, more knowledge, more structure and more time to discuss DNR. Most HCPs felt that it would be worth conducting a prospective clinical trial to determine the best time to discuss DNR.Conclusions: This pilot study provides a unique mixed quantitative and qualitative understanding of the perceptions of patients with lung cancer and their CGs and HCPs regarding DNR discussion. Our findings will help further the development of evidence-based guidelines and a broad prospective study that would have important implications for policies and practices around DNR discussions in order to reduce the emotional pain of dying patients, their CGs and HCPs.
Highlights
Most patients with lung cancer are found to have incurable diseases shortly after their diagnosis
Our findings will help further the development of evidence-based guidelines and a broad prospective study that would have important implications for policies and practices around Do Not Resuscitate (DNR) discussions in order to reduce the emotional pain of dying patients, their CGs and health care providers (HCPs)
Ten patients with advanced stage lung cancer, nine CGs and ten HCPs from the Thoracic Disease Site Group (DSG) were enrolled in the study
Summary
Most patients with lung cancer are found to have incurable diseases shortly after their diagnosis. While patients struggle to reconcile themselves with the reality of impending death, the families, nurses and oncologists involved in their care are faced with the challenge of finding the appropriate timing and environment to initiate End of Life (EOL) care discussions. One of the most commonly cited reports involving more than 9,000 patients with life-threatening diseases revealed that only 47% of physicians knew the DNR status of their patients and 46% of DNR orders were written within two days of death [2]. Do Not Resuscitate (DNR) is a significant but challenging part of end-of-life discussions when dealing with incurable lung cancer patients. We have explored the perceptions and preferences of patients, their caregivers (CGs), and health care providers (HCPs) and the current practice and opinions on DNR discussions in a multidisciplinary lung cancer clinic
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