菅原 斉

Aim This study aimed to clarify the current understanding/misunderstanding regarding the “do not attempt resuscitation (DNAR)” order among physicians and nurses in Japan as well as related factors. Methods We conducted a questionnaire survey of physicians and nurses working in three Japanese medical institutions. We established “misconception indicators” for DNAR orders and identified related factors using the Mann–Whitney U test, with multiple comparisons using the Dunn test. Differences in each misconception indicator were compared between physicians and nurses using the chi‐square test. Results We obtained survey responses from 134 physicians and 233 nurses. Among them, >70% of physicians and nurses responded that a DNAR order indicated withholding invasive medical care. Moreover, responses suggesting that DNAR prompted palliative care were more common among physicians and nurses working at hospitals without intensive care units or rapid response systems. Additionally, >40% of physicians responded that a DNAR order prompted them to limit the use of medical resources, including the intensive care unit and blood transfusions, with this proportion being higher than that among nurses. Further, physicians with longer clinical experience were more likely to limit the use of medical resources in cases of a DNAR order. Conclusions Many physicians and nurses misinterpreted a DNAR order as prompting palliative care. To facilitate support toward patient decision‐making and correct implementation of DNAR orders, it is important to establish internal guidelines, provide education regarding end‐of‐life care and medical terminology, and introduce specialized care teams.

We herein report a 47-year-old man who presented with progressive paraparesis. Imaging revealed a right upper pulmonary nodule, massive bilateral adrenal metastases, thoracolumbar vertebral osteolysis, and subcutaneous nodules. A biopsy of the right buttock nodule revealed a poorly differentiated metastatic carcinoma with high programmed cell death-ligand 1 expression and extensive chromosomal rearrangements. The patient died 10 days after the initiation of pembrolizumab treatment. Autopsy findings confirmed pulmonary pleomorphic carcinoma with extensive metastases. Quantification of chromosomal rearrangements revealed a jump-up mutation from the normal karyotype, followed by a further incremental increase in the degree of deviation.