Author of

• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11969

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    P2.24-023 - A descriptive pilot study to evaluate the current practices of determining "Do Not Resuscitate Status" in patients with incurable lung cancer at Cancer Care Manitoba, Canada. (ID 1570)

    09:30 - 09:30  |  Author(s): P. Johnston
    • Abstract

    Background
    At Cancer Care Manitoba (CCMB), Canada, lung cancer patients when considered incurable, are often enrolled into the palliative care program. One of the most important pre-requisites for patients to enroll into this program is to have a Do Not Resuscitate (DNR) status determined and signed by an authorized cancer care provider.Currently there are no guidelines on how and when to address advanced care planning and more specifically when to discuss DNR status. At this time the issue appears to be addressed on an individual basis depending on the patient’s unique circumstances and the personal practice of the physician involved. DNR discussions in the context of incurable lung cancer can be difficult for a number of reasons that include but are not limited to: social or family complexities such as dysfunctional dynamics or conflicted goals for medical attention, cultural differences, limited patient and/or family understanding of the patient’s prognosis, a recent diagnosis, limited time for discussion, physician preferences, and questionable patient cognitive competence secondary to pain, medications, brain metastases, whole brain radiotherapy, and emotional stress caused by the disclosure of incurable nature of the disease . Lung cancer team at CCMB has identified a need to explore the current practice and opinions around DNR discussion and future development of advance care planning guidelines. The findings from the current pilot study may serve the basis for a prospective randomized trial that tests an intervention that incorporates the timing of DNR discussions.

    Methods
    From January 2012 to November 2012 a total of 10 lung cancer patients who had previously discussed and determined their DNR status, 9 family members, and 10 health care providers were identified and agreed to participate. A mixed quantitative and qualitative methodology including a written questionnaire followed by a nurse directed audio recorded interview was employed to determine participant’s views. Interviews were transcribed and then content analysis and constant comparison techniques were used to identify, code, and categorize primary patterns in the collected data.

    Results
    Major themes identified from the patient and caregiver’s perspective include their trust in the health care system, the need for clear communication, the desire to be respected, and the benefit of having family present during discussion. Health care provider’s commonly expressed the importance of having adequate clinic time for discussions and the need for the process to be adaptable. Admission into a palliative care program is the most common trigger for initiating discussions but other points earlier in the disease course may also be appropriate. The presumed level of stress that patients are thought to undergo with DNR discussions is less than they actually report. Fnal data analysis is pending and subject to refinement before final presentation.

    Conclusion
    DNR status decision-making is a complex process, influenced by patient, family, and health care provider factors. The implementation of a standard approach to DNR discussions could potentially be restrictive. Potential areas of improvement include additional resources, and the specific guidelines. A need for a prospective trial addressing the timing of DNR discussion was identified but may not be feasible.