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Updated: Apr 30, 2026
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Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
Published on: August 5, 2020
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A communication training perspective on AND versus DNR directives.
1Communication and Research Training Laboratory, Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New York.
Palliative & Supportive Care
|April 30, 2014
Summary
The term "Allow Natural Death" (AND) improves end-of-life communication compared to "Do Not Resuscitate" (DNR). AND facilitates better discussions about palliative care goals and patient wishes.
Area of Science:
- Medical communication
- Palliative care
- End-of-life discussions
Background:
- The term "Do Not Resuscitate" (DNR) is communicationally challenging in end-of-life care.
- DNR omits crucial goals of care in discussions.
- "Allow Natural Death" (AND) is proposed as a more effective alternative.
Observation:
- A case study illustrates a nurse's difficulty using DNR in end-of-life goal discussions.
- Communication coaching with a trainer improved the nurse's ability to use AND.
- Successful use of AND facilitated palliative care communication and planning.
Findings:
- AND framing enhances end-of-life communication effectiveness.
- AND promotes more meaningful discussions about patient goals.
- A randomized controlled simulation study supports the use of AND.
Implications:
- AND offers advantages over DNR from a communication training perspective.
- Replacing DNR with AND can foster better end-of-life communication.
- The implications of "natural" versus "unnatural" death in communication warrant consideration.
Keywords:
Advance care directives
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