A Staff Dialogue on Do Not Resuscitate Orders: Psychosocial Issues Faced by Patients, Their Families, and Caregivers

Abstract

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non‐profit organization dedicated to supporting and advancing compassionate health care delivery which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of a woman who developed lymphoma was discussed at the July and August, 1997 Schwartz Center Rounds. There were considerable delays and uncertainties in the diagnosis, which was followed by an unpredictably chaotic clinical course. Although she had made it clear to her doctor that she did not want “heroic measures,” she had unexpectedly rallied so many times that her son and her husband wanted her doctors to do everything possible to keep her alive, including the performance of cardiopulmonary resuscitation (CPR). The clinical benefit of CPR in the event of cardiac arrest in those with cancer is discussed, as are do not resuscitate (DNR) orders, living wills, and healthcare proxies. In addition, the issues that surround DNR status, including who should discuss DNR status with a patient, and how and when it should be discussed, are reviewed. Staff raised concerns about the effect of discussing DNR status on the doctor‐patient relationship, and wondered whether writing DNR orders adversely affect the care of patients.

Informal Caregivers of Palliative Oncohematologic Patients

“…Ten articles (50% of those selected) [8][9][10][11][12][13][14][15][16][17] dealt with different aspects of the EOL care of oncohematologic patients from the caregiver point of view. These aspects included (see Table 3):…”

Práctica médica y sufrimiento espiritual (1ª parte)

“…Los clásicos decían cosas inteligibles pero difíciles de aceptar, como que es más digno del hombre sufrir el mal que hacerlo. Ponderamos como hermoso el pensamiento de que lo que realmente frustra una vida no es el dolor, sino la falta de amor; que el gran fracaso de una vida es haber vivido sin amar 3,17 . Es decir, palpamos un valor escondido en los momentos de prueba, y la existencia de valor en nuestra vida va unida a su sentido.…”

An exploratory, interview study of oncology patients' and health‐care staff experiences of discussing resuscitation

“…A review of the literature in this area has found very little research about how patients and their families would like discussions surrounding resuscitation to take place [11,14,19,20]. Published work suggests that not only do there appear to be concerns over how to conduct resuscitation discussions but also how to communicate resuscitation decisions to the wider health-care team [5,19,21].…”