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A communication training perspective on AND versus DNR directives

Published online by Cambridge University Press:  28 April 2014

Tomer T. Levin  and
Nessa Coyle
Tomer T. Levin*
Affiliation:
Communication and Research Training Laboratory, Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New York
Nessa Coyle
Affiliation:
Communication and Research Training Laboratory, Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Tomer T. Levin, Communication and Research Training Laboratory, Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, New York 10022. E-mail: levint@mskcc.org
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Abstract

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.

Case:

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.

Discussion:

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.

Keywords

Allow natural death (AND)Do not resuscitate (DNR)Communication trainingEnd-of-life communicationAdvance care directives
Type
Case Report
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 385 - 387
Copyright
Copyright © Cambridge University Press 2014 

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References

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