Regulatory and educational initiatives fail to promote discussions regarding end-of-life care

Andrew F. Shorr, Alexander S. Niven, David E. Katz, Joseph M. Parker, Arn H. Eliasson

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


We conducted an observational cohort study to determine if hospital-based, reinforcing regulatory and educational interventions could encourage physicians to discuss end-of-life (EOL) care with their patients. Specifically, we measured the effect of (1) administrative prompts to encourage discussions about EOL care and (2) a mandatory educational seminar focusing on EOL issues. Study subjects were patients consecutively admitted to the medicine service who faced an anticipated 3-year mortality rate of at least 50%. The main study endpoint was the frequency of documented EOL discussions between physicians and patients. In the inception cohort of 184 patients, physicians discussed EOL care with 64 patients (34.8%), and in the follow-up cohort of 121 patients, 41 individuals (33.9%) had documented discussions regarding EOL issues (P = 0.90). Actual 'Do Not Resuscitate'(DNR) orders were written for 53 patients (28.8%) in the inception cohort and for 33 persons (27.3%) in the follow-up cohort (P = 0.71). We conclude that enhanced, mutually reinforcing regulatory and educational efforts focusing on EOL care proved ineffectual at promoting either discussions about EOL issues or the use of DNR orders. Copyright (C) 2000 U.S. Cancer Pain Relief Committee.

Original languageEnglish (US)
Pages (from-to)168-173
Number of pages6
JournalJournal of pain and symptom management
Issue number3
StatePublished - Mar 2000


  • Do not resuscitate orders
  • Education
  • End-of-life care
  • Patient Self Determination Act

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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