18 Dec DNR Orders Improved Quality of Life In Week Before Death

MedicalResearch.com Interview with:
Melissa Garrido, PhD
Research Health Science Specialist
GRECC, James J Peters VA Medical Center, Bronx, NY
Assistant Professor Brookdale Department of Geriatrics & Palliative Medicine
Icahn School of Medicine at Mount Sinai, New York, NY and

Holly G. Prigerson, PhD
Center for Research on End of Life Care
Weill Cornell Medical College New York, NY 10065

Medical Research: What is the background for this study? What are the main findings?

Response: Recent proposals in Congress encourage patients to engage in advance care planning and to complete advance directives. That is, patients are encouraged to have conversations about end-of-life care preferences and to document these preferences in writing (through living wills or medical orders such as do not resuscitate (DNR) orders) or to designate a durable power of attorney who can honor their preferences. The goal of advance care planning is to ensure that seriously ill patients receive care that matches their values. In this study, we used data from a prospective study of patients with advanced cancer and their caregivers to examine whether living wills, durable powers of attorney, and DNR orders were associated with better quality of life and lower estimated costs of care in the week before death. We examined these relationships among patients who did and did not express preferences for “heroic” end-of-life care (everything possible to remain alive).

Medical Research: What are the main findings?

Response: DNR orders were associated with better quality of life in the week before death among the entire sample. If patients have DNR orders completed, they are likely to have a better quality of life/quality of death than if they do not complete a medical order like this.

We did not find any evidence of a relationship between DNR orders and costs of care, nor did we find evidence of relationships among living wills or durable powers of attorney, quality of life, and costs of care. There was no evidence that relationships among advance care planning and outcomes differed by patient preferences for heroic care.

Medical Research: What should clinicians and patients take away from your report?

Response: Completion of DNR orders is important for patients who do not desire resuscitation. It is also important to ensure that patients understand the benefits and risks of different options for treating serious illnesses so that they can make informed end-of-life care decisions.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Future studies should see whether advance directives and medical orders are associated with improved quality of life over longer time periods and use actual costs of care to determine more conclusively if DNR order completion is associated with lower health care costs.

“The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.”

Citation:

Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives

 Available online 11 December 2014
Melissa M. Garrido | Tracy A. Balboni | Paul K. Maciejewski | Yuhua Bao | Holly G. Prigerson

Journal of Pain and Symptom Management Available online 11 December 2014

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Last Updated on December 18, 2014 by Marie Benz MD FAAD