Characteristics Of Patients Who Refuse Medically Appropriate Do Not Resuscitate Orders (Dnr) Upon Admission To A Palliative Care (Pc) Unit In A Comprehensive Cancer Center

9589 Background: Cardiopulmonary resuscitation (CPR) has limited benefit in advanced cancer patients (pts). Refusal of medically appropriate DNR (maDNR) may cause harm and distress for pts, families, and the medical team. We conducted a retrospective study to determine the frequency of refusals of maDNR in a tertiary PC unit in a comprehensive cancer center, and characterize the differences between maDNR acceptors (A) and refusers (R). Methods: We reviewed 2538 consecutive admissions to the PC unit to find refusals of maDNR. Data were collected regarding demographical/clinical factors, 0–10 Edmonton Symptom Assessment System, DNR, CPR, and death for the first 100 R and 200 A pts. Results: DNR was considered medically appropriate for 2530/2538 (99%) admissions. 2374/2530 admissions were of unique pts, and 100/2374 (4%) refused maDNR. 3/3 (100%) R pts who coded underwent CPR versus 0/87 A pts who coded (0%, p<0.0001). 2/3 CPR pts survived code and were discharged but died in less than 10 days. Median age (62), female gender (54%), and religious affiliation were not different between R and A. African-Americans and pts with head and neck malignancies were more frequently R than others (OR=1.99, CI=1.13–3.51, p=0.02 and OR=2.62, CI=1.05–6.56, p=0.04, respectively). A had more hematological malignancies and advance directives (OR=2.66, CI=1.07–6.63, p=0.02, and OR=2.80, CI=1.68–4.66, p<0.0001, respectively). Multivariate regression analysis revealed that pts with hematologic malignancies (OR 2.69, CI=1.05–6.90 p= 0.04) and advance directives (OR 1.46, CI=1.46–4.27, p= 0.001) were associated with A. R pts presented with median (interquartile range, IR) pain of 7(4–9) vs 5(3–8, p=0.0005) nausea of 2(0–7) vs 1(0–4, p=0.05), and dyspnea of 1(0–5) vs 4(0–7, p=0.002). Median (IR) time between PC consult and death and discharge and death were 143 (49–329) days for R vs 25(10–77) for A (p<0.0001) and 85 (25–206) for R and 18 (8–35) for A (p<0.0001). Conclusions: DNR refusal in pts after PC consult is low, more frequent among African Americans, pts with head and neck cancers, pts with more pain or nausea, and is associated with longer survival. This study demonstrates possible predictors of complicated DNR discussions. No significant financial relationships to disclose.