| Changes in medical care at a pediatric oncology referral center after placement of a do-not-resuscitate order. | |
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MedLine Citation:
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PMID: 21034279 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Justin N Baker; Javier R Kane; Shesh Rai; Scott C Howard; Pamela S Hinds; |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-10-30 |
Journal Detail:
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Title: Journal of palliative medicine Volume: 13 ISSN: 1557-7740 ISO Abbreviation: J Palliat Med Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2011-04-01 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 9808462 Medline TA: J Palliat Med Country: United States |
Other Details:
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Languages: eng Pagination: 1349-52 Citation Subset: IM |
Affiliation:
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Department of Pediatric Medicine, Division of Palliative and End-of-Life Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. justin.baker@stjude.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Cancer Care Facilities Child Child, Preschool Cohort Studies Female Hospitals, Pediatric* Humans Infant Infant, Newborn Male Medical Audit Pediatrics Resuscitation Orders* Retrospective Studies Tennessee Terminal Care / methods, standards* Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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P30 CA21765/CA/NCI NIH HHS |
| Investigator | |
Investigator/Affiliation:
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Christine A Zawistowski / ; Elizabeth A Burghen / ; Jami S Gattuso / ; Nancy Nancy / ; Ashley Ashley / ; Jennifer Althoff / ; Kristen Macintyre / ; Adam Funk / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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