title: Physician perspectives on resuscitation status and DNR order in elderly cancer patients.
abstract: OBJECTIVE
  To evaluate the process of placing DNR order in elderly cancer patients in practice and analysis of physician perspectives on the issue.
  
  
  BACKGROUND
  Decision not to resuscitate (DNR/DNAR) is part of practice in elderly cancer care. Physicians issue such orders when a patient is suffering from irreversible disease and the patient's life is coming to an end. Modern practice emphasises the need of communication with the patients and their relatives while issuing a DNR. The decision making process of placing DNR can be quite daunting. The moral and ethical dimensions surrounding such a decision make it a contentious topic.
  
  
  METHODS
  We searched the literature to find relevant works that would help physicians and especially the junior health care staff in dealing with the complexities. In this article, we discuss the issues that physicians encounter whilst dealing with a DNR order in elderly cancer patients.
  
  
  RESULTS
  There are no objective adjuncts or guidelines directed towards the approach of placing a DNR in elderly cancer patients. Better communication with the patients and relatives when making such decision remains a very important aspect of a DNR decision. Most health care staff find themselves ill equipped to deal with such situation. Active training and briefing of junior staff would help them deal better with the stresses involved in this process.
  
  
  CONCLUSIONS
  There are complex psychosocial, medical, ethical and emotive aspects associated with placing a DNR order. Patients and their loved ones and the junior staff involved in the care of patient need early communication and briefing for better acceptance of DNR. Studies that could devise or identify tools or recommendations would be welcome.
authors.affiliation: Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK.
authors.forename: Sachin
authors.initials: S
authors.lastname: Trivedi
keywords: Advanced directives; Cancer in the elderly; DNR; Resuscitation