Centre for Research Ethics & Bioethics (CRB)

DNR decisions within oncology and hematology care. Clinical and ethical perspectives

Within oncology and hematology care, patients in a terminal phase of cancer sometimes have such a poor prognosis that Coronary Pulmonary Rescue (CPR) is not considered justifiable in case of cardiac arrest.

This can lead to a DNR order to be issued by the responsible physician, implying that in case of a cardiac arrest neither basic nor advanced CPR is to be performed. DNR situations can lead to severe ethical dilemmas and moral distress among the staff.

Aims

The aim of this project is to investigate attitudes to and perceptions of ‘Do Not Resuscitate’ (DNR) orders among staff in oncology and hematology care. The need for a certain ethical competence for these decisions will be investigated. Further the experiences of education in DNR and understanding of DNR orders among students in nursing and medical school will be investigated.

Research design

The project consists of four studies:

  1. In an interview study, using qualitative methodology, oncology and hematology nurses will be asked about their experiences and perceptions of DNR decisions.
  2. In a similar qualitative study, physicians working within oncology and hematology will be interviewed on their experiences and perceptions of DNR decisions.
  3. Based on the empirical results in study 1 and 2 an analysis of what ethical competence staff needs in order to make sound decisions concerning DNR within oncology and hematology care will be performed.
  4. In a quantitative study, using a web based survey, nursing and medical students will be investigated concerning their understanding of DNR and their education on this concept.

about the project

This PhD project is funded by The Swedish Cancer Society (Cancerfonden) and runs from 2010-2018.

Contact

Supervisors

  • Anna T. Höglund, Associate Professor of Ethics
  • Mariann Hedström, Senior lecturer, Department of Public Health and Caring Science

Collaborator

  • Gunnar Birgegård, Professor, Department of Medical Sciences

Publications

Pettersson M, Hedström M and Höglund AT, Striving for good nursing care: Nurses' experiences of do not resuscitate orders within oncology and hematology care, Nursing Ethics published online 9 June 2014, DOI: 10.1177/0969733014533238

Nursing Ethics & Ethics of Care

Nursing ethics is concerned with the moral dimensions of nursing practice while the ethics of care is a normative ethical theory. For many years CRB has developed these fields from different angles. We have used qualitative studies to describe and explore the kinds of ethical dilemmas nurses encounter in their day-to-day work and how they solve them. Other studies have investigated the role of ethical guidelines in the building of ethical competence in nursing practice and in priority setting. In this report, we provide a summary of our research.

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Nursing ethics & ethics of care