Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12233
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dc.contributor.authorAzad, Arun Aen
dc.contributor.authorSiow, Sue-Fayeen
dc.contributor.authorTafreshi, Alien
dc.contributor.authorMoran, Julien
dc.contributor.authorFranco, Michaelen
dc.date.accessioned2015-05-16T01:53:27Z
dc.date.available2015-05-16T01:53:27Z
dc.date.issued2014-05-27en
dc.identifier.citationJournal of Palliative Medicine 2014; 17(7): 776-81en
dc.identifier.govdoc24865307en
dc.identifier.otherPUBMEDen
dc.identifier.urihttp://ahro.austin.org.au/austinjspui/handle/1/12233en
dc.description.abstractDo-not-resuscitate (DNR) orders prevent medically futile attempts at resuscitation but are not always instituted in hospitalized patients with advanced cancer. One explanation for this underuse is the perception that DNR orders are inevitably associated with withdrawal of all medical interventions and inpatient death.To audit discharge and survival outcomes and changes in clinical management in hospitalized adult oncology patients with a DNR order, allowing an assessment of whether such orders lead to cessation of acute interventions and high rates of in-hospital death.Retrospective data were collected from 270 oncology inpatients at Austin Health, Melbourne, Australia, between February 1, 2012 and November 30, 2012.Mean and median time to institution of DNR orders after admission were 2.1 and 1.0 days, respectively (interquartile range, 0-2 days). Medical interventions continued in 80% or more of cases after DNR orders were placed included blood draws, intravenous antimicrobials, imaging, blood products, and radiotherapy. Two-thirds of patients survived hospitalization and were discharged alive. Survival at 30 days and 90 days after DNR orders were implemented was 63% and 33%, respectively. Baseline Charlson Comorbidity Index score of 5 or less and Eastern Cooperative Oncology Group performance status of 2 or less were associated with a higher probability of being discharged alive and longer overall survival.Most medical interventions were continued with high frequency in adult oncology inpatients after placement of DNR orders. A majority of patients survived hospitalization and remained alive at 30 days after DNR orders were documented. This study offers some reassurance that DNR orders do not inevitably lead to cessation of appropriate medical treatment.en
dc.language.isoenen
dc.subject.otherAdulten
dc.subject.otherAgeden
dc.subject.otherAged, 80 and overen
dc.subject.otherFemaleen
dc.subject.otherHospital Mortalityen
dc.subject.otherHumansen
dc.subject.otherMaleen
dc.subject.otherMiddle Ageden
dc.subject.otherMultivariate Analysisen
dc.subject.otherNeoplasms.mortality.therapyen
dc.subject.otherPatient Discharge.statistics & numerical dataen
dc.subject.otherPhysician's Practice Patternsen
dc.subject.otherResuscitation Ordersen
dc.subject.otherRetrospective Studiesen
dc.subject.otherSurvival Analysisen
dc.subject.otherVictoriaen
dc.titleDischarge patterns, survival outcomes, and changes in clinical management of hospitalized adult patients with cancer with a do-not-resuscitate order.en
dc.typeJournal Articleen
dc.identifier.journaltitleJournal of palliative medicineen
dc.identifier.affiliation1 Joint Austin-Ludwig Oncology Unit, Austin Health , Melbourne, Australia .en
dc.identifier.doi10.1089/jpm.2013.0554en
dc.description.pages776-81en
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/24865307en
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