The Do‐Not‐Resuscitate Order for Children With Terminal Cancer Admitted to a Palliative Care Unit

Introduction Research on do‐not‐resuscitate (DNR) orders mainly focuses on adult patients, with only a few studies investigating children. We aimed to investigate the use of DNR orders and factors associated with the signing of a DNR order among children with terminal cancer in mainland China. Methods This study was a retrospective analysis involving children with terminal cancer who died in the palliative care unit of a large‐scale tertiary teaching hospital in western China between July 31, 2015, and August 31, 2021. The DNR order information, demographics, and disease‐related characteristics of admitted children were analyzed. Results All DNR orders were signed by the children’s legal guardians, mainly within 3 days of death. The time to signing a DNR order was associated with disease severity, prior antitumor treatment, and overall survival time. The most common symptoms in these children were pain, restlessness, and dyspnea. Most of them had multiple distressing symptoms. Conclusions Our findings indicate that the DNR order is highly accepted by the families of children receiving palliative care, but very few children receive palliative care services in mainland China. It is necessary to improve palliative care for children and develop clearer guidelines to standardize DNR practices in mainland China.