ArticleCancer2017
Processes of code status transitions in hospitalized patients with advanced cancer.
Article in Cancer, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis.JAMA network open · 2019Pooled it
- Early and late code status documentation in cancer patients managed by a dedicated supportive care team.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Physicians' opinion of patients' CPR decision: Secondary analysis from a pilot RCT.Resuscitation plus · 2025Article
- Hospital and Temporal Variations in Limitations of Care Among Hospitalized Patients with COVID-19: A VIRUS Registry Retrospective Cohort Study.Palliative medicine reports · 2025Article
- Racial disparities in the frequency and timing of code status orders among women with breast cancer.BMC cancer · 2024Article
- Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis.Palliative medicine reports · 2024Article
- Code status transitions in patients with high-risk acute myeloid leukemia.Blood advances · 2022Article
- Associations of prognostic-awareness-transition patterns with end-of-life care in cancer patients' last month.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Article
- The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.The American journal of hospice & palliative care · 2021Article
- The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer.Journal of palliative medicine · 2020Article
- Lack of Advance Care Planning before Terminal Oncology Intensive Care Unit Admissions.Journal of palliative medicine · 2020Article
- TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records.Journal of patient safety · 2019Article
- End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model.Nursing outlookArticle
Corrections and comments
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Authors and funding
13 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAlthough hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown.
methodsWe conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR.
resultsIn total, 1047 hospitalizations were reviewed among 728 patients. Admitting clinicians did not address code status in 53% of hospitalizations, resulting in code status orders of "presumed full." In total, 275 patients (26.3%) transitioned from full code to DNR, and 48.7% (134 of 275 patients) of those had an order of "presumed full" at admission; however, upon further clarification, the patients expressed that they had wished to be DNR before the hospitalization. We identified 3 additional processes leading to order transition from full code to DNR acute clinical deterioration (15.3%), discontinuation of cancer-directed therapy (17.1%), and education about the potential harms/futility of CPR (15.3%). Compared with discontinuing therapy and education, transitions because of acute clinical deterioration were associated with less patient involvement (P = .002), a shorter time to death (P < .001), and a greater likelihood of inpatient death (P = .005).
conclusionsOne-half of code status order changes among hospitalized patients with advanced cancer were because of full code orders in patients who had a preference for DNR before hospitalization. Transitions due of acute clinical deterioration were associated with less patient engagement and a higher likelihood of inpatient death. Cancer 2017;123:4895-902. © 2017 American Cancer Society.
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