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Do-Not-Resuscitate Orders in Children Change Care

TUESDAY, Aug. 27 (HealthDay News) -- Most clinicians dealing with do-not-resuscitate (DNR) orders in children report that patient care changes as a result of such orders, and most discussions about resuscitation take place later than is ideal, according to research published online Aug. 26 in JAMA Pediatrics.

Amy Sanderson, M.D., from Boston Children's Hospital, and colleagues surveyed 107 physicians and 159 nurses working in practice settings where advance care planning typically takes place about their attitudes and behaviors towards DNR orders in children.

The researchers found that 66.9 percent of clinicians thought that a DNR order implied limitation of resuscitative measures only on cardiopulmonary arrest, but more than 85 percent reported that care changes beyond the response to cardiopulmonary arrest, ranging from focusing on comfort to reduced clinician attentiveness. Most clinicians reported that discussions about resuscitation occur later in an illness than is ideal.

"Interventions aimed at improving clinician knowledge and skills in advance care discussions as well as the development of orders that address overall goals of care may aid clinicians in making informed, appropriate medical decisions for patients with life-threatening conditions," Sanderson and colleagues write.

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