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1 results

  • A communication training perspective on AND versus DNR directives

  • Tomer T. Levin, Nessa Coyle
  • Journal:
    Palliative & Supportive Care / Volume 13 / Issue 2 / April 2015
    Published online by Cambridge University Press:
    28 April 2014, pp. 385-387
  • 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.