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Factors Influencing Do-Not-Resuscitate Status in Children During Last Month of Life

Single Institution Experience

Moaed, Bilal, RN; Mordechai, Oz, MD; Weyl Ben-Arush, Myriam, MD; Tamir, Sharon, MA; Ofir, Ruth, RN, MA; Postovsky, Sergey, MD

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p e201–e205
doi: 10.1097/MPH.0000000000001360
Online Articles: Original Articles

Background: It is currently expected that about 20% of children with cancer will ultimately die. Writing advanced life directives sufficiently long before the actual death of a child ensues allows both parents and medical staff to develop optimal treatment plans in the best interests of the child.

Aim of the study: The aim of the study was to evaluate factors that may influence the process of decision-making regarding Do-Not-Resuscitate (DNR) status.

Methods: Retrospective single institution study.

Results: Totally, 79 patients died between September 01, 2011 and August 31, 2017. Median age of the children was 10.5 years (range, 1 to 24 y). Forty-five were males. There were 37 Muslims, 27 Jews, 9 Druze, and 6 Christians. Twenty-one patients had sarcomas, 20 had CNS tumors, 10 had neuroblastoma, 17 had leukemias/lymphomas, 11 had carcinomas, and other rare tumors as well as nonmalignant diseases. No statistically significant association between all evaluated factors and DNR order status was found.

Conclusions: It is possible that, other than demographic, clinical-associated, or therapy-associated factors play an important role in the process of decision-making regarding DNR. We feel that sincere communication between parents, their child (when appropriate) and medical and psychosocial staff may have a more crucial role when such decisions have to be made.

Division of Pediatric Hematology/Oncology, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel

The authors declare no conflict of interest.

Reprints: Sergey Postovsky, MD, Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel (e-mail:

Received April 29, 2018

Accepted October 23, 2018

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