ASCO: DNR Completion at End of Life Influenced by Perception of Caregiver Support

June 3, 2013

Results of a new study indicated that patients with terminal cancer are more likely to have completed a do-not-resuscitate order when they prefer, and believe that their caregiver prefers, comfort at the end of life.

CHICAGO-Results of a new study indicated that patients with terminal cancer are more likely to have completed a do-not-resuscitate (DNR) order when they prefer-and believe that their caregiver prefers-comfort at the end of life. This study, which examined how family caregivers influence cancer patients’ advance care planning, was presented at the annual meeting of the American Society of Clinical Oncology (ASCO).

“There is still a great deal we don’t know about how advanced cancer patients and their family caregivers make decisions as a dyad,” said Kalen Michele Fletcher, of Dana-Farber Cancer Institute. “While it is clear that family caregivers of advanced cancer patients provide immense amounts of material and psychological support for the patients they care for, and often attend the majority of these patients’ oncology appointments, it is unclear what type of influence they have over the end-of-life decisions these patients make.”

Ms. Fletcher and colleagues recruited participants in the Coping with Cancer II study to participate. Patients had to be diagnosed with advanced cancer, be aged 20 years or older, have adequate stamina to complete an interview, and have fluency in English or Spanish.

Patients were asked to choose their own preference to, and what they believed to be their family’s preference to the following choice for a course of treatment:

1. A course of treatment that focused on extending life as much as possible, even if it meant more pain and discomfort, or 2. A plan of care that focused on relieving pain and discomfort as much as possible, even if that meant not living as long.

Patients were also asked if they had completed a DNR.

In addition, the researchers presented the same two options to the family caregivers, for them to select their preference for their family member with advanced cancer.

“Patients who prefer comfort care to life-extending care at the end of life, and who think that their caregivers also want them to pursue comfort care, were more likely to report having completed a DNR,” Ms. Fletcher said.

Results indicated that these patients had a 3.67 odds ratio for having completed a DNR (P = .013). Interestingly, patients’ perception of this agreement was a stronger predictor of reported DNR completion than actual agreement.

“It seems important that oncologists engage patients and family caregivers in discussions about end-of-life care so that patients feel like their goals for comfort care are supported by their family caregivers,” Ms. Fletcher said. “More research needs to be done to discern what other types of end-of-life decisions caregivers influence.”