I am concerned about some of our patients with advanced cancer being full code. Is it within my scope to address this with patients, and if so, what is the best approach? — Kerstin L. McSteen, BSN, MSN, ACHPN, CNS-BC, Minneapolis, MN

Any member of the patient’s health care team can discuss issues regarding code status; however, the DNR or “Do Not Resuscitate” directive needs to ultimately exist as a medical order from the health care professional legally able to initiate such medical decisions. Who can do this may vary from state to state and may include a nurse practitioner or physician assistant in addition to a physician. That person, the patient, and family members need to concur with its appropriateness.

When dealing with terminally ill cancer patients and their families, I believe it is helpful to stress that “it’s time to do things for the patient and not do things to the patient.” This shift signifies that we have arrived at the point where supportive care alone is the best management and that the health care team is not abandoning the patient. — Donald Fleming, MD

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