Changes in medical care at a pediatric oncology referral center after placement of a do-not-resuscitate order

Justin N. Baker, Javier R. Kane, Shesh Rai, Scott Howard, Pamela S. Hinds

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: Parents may fear that a do-not-resuscitate (DNR) order will result in reduction of the level, quality, and priority of their child's medical care. We therefore assessed medical care that was continued, added, and discontinued after a DNR order was placed in the medical record. Patients/methods: Retrospective review of the charts of 200 pediatric oncology patients at St. Jude Children's Research Hospital who died between July 1, 2001 and February 28, 2005, were younger than 22 years old at death, and had a documented DNR order. Medical interventions that were added (between the DNR order and death), continued (not discontinued between 24 hours before and 72 hours after DNR), and discontinued (within 72 hours after DNR) were identified and compared by using binomial proportions. Results: With the exception of chemotherapy, the studied medical interventions that patients were receiving at the time of the DNR order were continued in 66.7% to 99.3% of cases. Chemotherapy was continued in 33.3%. The most frequently added interventions were oxygen, steroids, and pain medicine. The most frequently discontinued interventions were laboratory draws, chemotherapy, antibiotics, and parenteral nutrition. Conclusions: In this cohort of pediatric oncology patients, the medical interventions being received were continued with a high frequency after placement of a DNR order. Chemotherapy was continued only in a minority of patients, possibly signifying a shift in goals. These findings may help to reassure families that a DNR order need not result in a change in any of their child's medical therapies which appropriately advance the defined goals of care.

Original languageEnglish (US)
Pages (from-to)1349-1352
Number of pages4
JournalJournal of Palliative Medicine
Volume13
Issue number11
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

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Resuscitation Orders
Referral and Consultation
Pediatrics
Drug Therapy
Patient Care Planning
Medical Oncology
Parenteral Nutrition
Child Care
Fear
Medical Records
Parents
Steroids
Medicine
Oxygen
Anti-Bacterial Agents
Pain

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

Cite this

Changes in medical care at a pediatric oncology referral center after placement of a do-not-resuscitate order. / Baker, Justin N.; Kane, Javier R.; Rai, Shesh; Howard, Scott; Hinds, Pamela S.

In: Journal of Palliative Medicine, Vol. 13, No. 11, 01.11.2010, p. 1349-1352.

Research output: Contribution to journalArticle

Baker, Justin N. ; Kane, Javier R. ; Rai, Shesh ; Howard, Scott ; Hinds, Pamela S. / Changes in medical care at a pediatric oncology referral center after placement of a do-not-resuscitate order. In: Journal of Palliative Medicine. 2010 ; Vol. 13, No. 11. pp. 1349-1352.
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