title: How, When and Where to Discuss Do Not Resuscitate: A Prospective Study to Compare the Perceptions and Preferences of Patients, Caregivers, and Health Care Providers in a Multidisciplinary Lung Cancer Clinic.
abstract: BACKGROUND
  Do Not Resuscitate (DNR) is a significant but challenging part of end-of-life discussions when dealing with incurable lung cancer patients. We have explored the perceptions and preferences of patients, their caregivers (CGs), and health care providers (HCPs) and the current practice and opinions on DNR discussions in a multidisciplinary lung cancer clinic.
  
  
  METHODS
  This is a prospective descriptive study with a mixed quantitative and qualitative methodology to capture perceptions of the participants. To obtain a rich description of participant responses to questionnaire items, we employed a 'think aloud' process that prompted participants to immediately verbalize their thoughts when responding to questionnaire items. We used content analysis and constant comparison techniques to identify, code and categorize primary themes in the captured data.
  
  
  RESULTS
  Ten patients with advanced-stage lung cancer; nine CGs from the lung clinic and ten HCPs from the Thoracic Disease Site Group (DSG) were enrolled in the study. Most patients had only a limited understanding of DNR. Most CGs had a fair to good understanding of DNR. Most HCPs perceived their patients to have understood DNR most of the time. When patients were interviewed, a theme of "anticipated discussion" about DNR was identified. Patients and CGs expressed having faith in the system and responsible physicians as to when to discuss DNR. HCPs embraced a clinician preference-based decision-making approach to engaging in DNR discussions. They desired more resources, more knowledge, more structure and more time to discuss DNR. Most HCPs felt that it would be worth conducting a prospective clinical trial to determine the best time to discuss DNR.
  
  
  CONCLUSIONS
  This pilot study provides a unique mixed quantitative and qualitative understanding of the perceptions of patients with lung cancer and their CGs and HCPs regarding DNR discussion. Our findings will help further the development of evidence-based guidelines and a broad prospective study that would have important implications for policies and practices around DNR discussions in order to reduce the emotional pain of dying patients, their CGs and HCPs.
authors.affiliation: Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Canada.
authors.forename: Naseer
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Faculty of Nursing, University of Manitoba, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lobchuk
authors.affiliation: Radiation Oncology, Tom Baker Cancer Centre.
authors.forename: William M
authors.initials: WM
authors.lastname: Hunter
authors.affiliation: Department of Nursing, Cancer Care Manitoba, Canada.
authors.forename: Pam
authors.initials: P
authors.lastname: Johnston
authors.affiliation: Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, Canada.
authors.forename: Zoann
authors.initials: Z
authors.lastname: Nugent
authors.affiliation: Cancer Care Manitoba, University of Manitoba, Canada.
authors.forename: Ankur
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Radiation Oncology, Cancer Care Manitoba, University of Manitoba, Canada.
authors.forename: Shahida
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Family Medicine, University of Manitoba, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Sisler
keywords: dnr; lung cancer