A communication training perspective on AND versus DNR directives.
BACKGROUND
From a communication perspective, the term "do not resuscitate" (DNR) is challenging to use in end-of-life discussions because it omits the goals of care. An alternative, "Allow Natural Death" (AND), has been proposed as a better way of framing this palliative care discussion.


METHODS
We present a case where a nurse unsuccessfully discusses end-of-life goals of care using the term DNR. Subsequently, with the aid of a communication trainer, he is coached to successfully use the term "AND" to facilitate this discussion and advance his goal of palliative care communication and planning.


CONCLUSIONS
We contrast the advantages and disadvantages of the term AND from the communication training perspective and suggest that AND-framing language replace DNR as a better way to facilitate meaningful end-of-life communication. One well-designed, randomized, controlled simulation study supports this practice. We also consider the communication implications of "natural" versus "unnatural" death.
Communication and Research Training Laboratory, Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New York.
Tomer T
TT
Levin
Communication and Research Training Laboratory, Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New York.
Nessa
N
Coyle
D000328:Adult; D001293:Attitude to Death; D003142:Communication; D003657:Decision Making; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D065126:Palliative Medicine / Q000193:education*; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D009626:Terminology as Topic
Advance care directives