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Shayya A, Young Y. End-of-Life Medical Decisions: The Link Between Sociodemographic Characteristics and Treatment Preferences. Am J Hosp Palliat Care 2024; 41:1173-1183. [PMID: 38008990 DOI: 10.1177/10499091231218988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION Advance directives (ADs) promote patient autonomy in end-of-life (EOL) care, including an individual's EOL medical treatment preferences. This study aims to better understand preferences regarding EOL medical treatment among community-dwelling adults (18 and older) residing in the United States and examine the association between sociodemographic characteristics and EOL medical treatment preferences. METHODS Utilizing a cross-sectional study and snowball sampling methodology, community-dwelling adults completed a survey containing two different ADs and a questionnaire with sociodemographic information. Univariate analyses were used to summarize EOL medical treatment preferences among the sample, and bivariate analyses (Chi-square and Fisher's Exact tests) were performed to examine the association between sociodemographic characteristics (age, gender, and race/ethnicity) and EOL medical treatment preferences. RESULTS The mean age of the 166 participants was 50 (SD: 21.65, range: 18-93), with 58.4% being White and 61.4% being female. Generally, when EOL scenarios involved brain damage or a coma, more participants indicated that they did not want life-support treatment. Age and race were both associated with EOL medical treatment preferences, but no significant differences were observed in the bivariate results by gender. Largely, young and middle-aged adults, along with Black participants, were more likely to prefer more aggressive EOL medical treatments than older adults and White participants. CONCLUSION Overall, EOL medical treatment preferences varied among participants. The study findings indicate that adults develop different preferences for EOL medical treatment, with some of the variation attributable to sociodemographic characteristics such as age and race.
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Affiliation(s)
- Ashley Shayya
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
| | - Yuchi Young
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
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López-Ávila A, Rivas-Riveros E, Campillay-Campillay M. Do not resuscitate orders and limitation of therapeutic effort: Ethical challenges in healthcare teams in Chile. Salud Colect 2024; 20:e4821. [PMID: 38961602 DOI: 10.18294/sc.2024.4821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024] Open
Abstract
The purpose of this paper is to delve into the ethical aspects experienced by the healthcare team when they receive the directive to limit therapeutic effort or a do-not-resuscitate order. From an interpretative, qualitative paradigm with a content analysis approach, a process based on three phases was conducted: pre-analysis in which categories were identified, the projection of the analysis, and inductive analysis. During 2023, interviews were conducted in the clinical setting of a high-complexity hospital in Chile with 56 members of the healthcare teams from critical and emergency units, from which four categories emerged: a) the risk of violating patients' rights by using do-not-resuscitate orders and limiting therapeutic effort; b) the gap in the interpretation of the legal framework addressing the care and attention of patients at the end of life or with terminal illnesses by the healthcare team; c) ethical conflicts in end-of-life care; and d) efficient care versus holistic care in patients with terminal illness. There are significant gaps in bioethics training and aspects of a good death in healthcare teams facing the directive to limit therapeutic effort and not resuscitate. It is suggested to train personnel and work on a consensus guide to address the ethical aspects of a good death.
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Affiliation(s)
- Ana López-Ávila
- Magíster en Epidemiología Clínica. Enfermera clínica, Hospital Regional de Talca, Chile
| | - Edith Rivas-Riveros
- Doctora en Enfermería. Directora, Maestría en Enfermería, Universidad de La Frontera, Temuco, Chile
| | - Maggie Campillay-Campillay
- Doctora en Enfermería. Coordinadora, Maestría de Investigación en Metodologías Cualitativas para la Salud, Universidad de Atacama, Copiapó, Chile
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The effect of joint involvement of nurse and physician in hospice care on terminal cancer patients on do-not-resuscitate orders signed by surrogates. Palliat Support Care 2022:1-7. [PMID: 35754401 DOI: 10.1017/s147895152200061x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Patients with terminal cancer often experience physical and mental distress. Signing a do-not-resuscitate order (DNR) is crucial to protect against invalid treatment. This study aims to explore the effect of hospice shared care intervention by medical staff on the completion of a DNR-S (DNR order signed by surrogates) for patients with terminal cancer. METHOD The cross-sectional study in this research involved secondary analysis of data from the 2011-2015 clinical cancer case management database of a medical center in central Taiwan. Those with a DNR order signed by patients (DNR-P) or DNR-S before the hospice shared care consultation were excluded from this study; a total of 1,306 patients with terminal cancer were selected. RESULTS This study demonstrated that the percentage of DNR-S after consultation involving both nurse and physician was 75.4%. With other variables controlled, the number of DNR-Ss after consultation with a nurse was significantly lower [odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.42-0.75] and that of DNR-Ss after consultation involving both nurse and physician was significantly higher (OR = 1.35, 95% CI = 1.01-1.79), than that of DNR-Ss after consultation with only the physician. SIGNIFICANCE OF RESULTS Joint involvement of the nurse and physician in hospice care provides sufficient information to patients and family with terminal cancer about their condition and enhances doctor-patient communication. This effectively assists patients with terminal cancer and their family members in making the major decision of signing a DNR, alleviates the concerns of patients and family members about signing a DNR, and reduces terminal cancer patients' pain at the end of life to ensure that they die in peace and dignity.
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van der Werff HFL, Michelet TH, Fredheim OM, Steine S. "Do not resuscitate" order and end-of-life treatment in a cohort of deceased in a Norwegian University Hospital. Acta Anaesthesiol Scand 2022; 66:1009-1015. [PMID: 35699950 PMCID: PMC9544634 DOI: 10.1111/aas.14104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/31/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Abstract
Background A “Do not resuscitate” (DNR) order implies that cardiopulmonary resuscitation will not be started. Absent or delayed DNR orders in advanced chronic disease may indicate suboptimal communication about disease stage, prognosis, and treatment goals. The study objective was to determine clinical practice and patient involvement regarding DNR and the prevalence of life‐prolonging treatment in the last week of life. Methods A cross‐sectional observational study was made of a cohort of 315 deceased from a large general hospital in Norway. Data on DNR and other treatment limitations, life‐prolonging treatment in the last week of life, and cause of death were obtained from medical records. Results A DNR order was documented for 287 (91%) patients. Almost half the DNR orders, 142 (49%), were made during the last 7 days of life. The main causes of death were cancer (31%), infectious diseases (31%), and cardiovascular diseases (19%). The most frequent life‐prolonging treatments during the last week of life were intravenous fluids in 221 patients (70%) and antibiotics in 198 (63%). During the last week of life, 103 (36%) patients received ICU treatment. Death by cancer (odds ratio 2.5, 95% confidence interval 1.24–5.65) and DNR decision made by a palliative care physician (odds ratio 3.4, 95% CI 1.21–3.88) were predictors of not receiving life‐prolonging treatment. Conclusion The findings of a high prevalence of life‐prolonging treatment in the last week of life and DNR orders being made close to the time of death indicate that decisions about limiting life‐prolonging treatment are often postponed until the patient's death is imminent.
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Affiliation(s)
| | - Torstein H Michelet
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Olav M Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs Hospital, Trondheim, Norway
| | - Siri Steine
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
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Fan R, Yang S, Bu X, Chen Y, Wang Y, Shen B, Qiu C, Li X. Symptomatic Features and Factors Associated With Do-Not-Resuscitate Consent in Advanced Cancer Patients Admitted to Palliative Care Ward. Am J Hosp Palliat Care 2022; 39:1312-1324. [PMID: 35041534 DOI: 10.1177/10499091211068824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to conduct a retrospective cross-sectional study to investigate the prevalence of symptoms and symptom clusters on sociodemographic and disease characteristics, as well as factors associated with Do-Not-Resuscitate (DNR) consent. Advanced cancer patients were enrolled between 2018 and 2020 with available data. Demographic and clinical data were obtained for analysis from Hospital Information System (HIS) in China. Symptom clusters were extracted by hierarchical cluster analysis. Chi-square test and multiple logistic regression were conducted to investigate the prevalence characteristics of symptoms and influencing factors of DNR consent, respectively. 798 advanced cancer patients were enrolled. The most prevalent symptoms were pain (93%), anorexia (36.5%), and sleep disorders (34.2%). High heart rate was associated with poor performance status and more symptoms. Three clusters were extracted: fatigue-related, respiratory-circulatory system, and digestive system symptom clusters. The incidence of symptoms was statistically significant in age, gender, education level, residence, BMI, performance status, distress score, ADL, and primary pain level. The DNR signature rate was 15.5%. Female, distant metastasis, in-ward rescue, and appearance of dyspnea were independent influencing factors of DNR signature.Chinese hospitalized cancer patients had more symptoms burden that were influenced by various demographic characteristics, especially pain and fatigue-related symptoms. Concerning the trajectory of vital signs is important among advanced cancer patients. The DNR signature rate was lower and our finding indicating an urgency to accurately assess the prognosis and give more palliative care education to enhance DNR rates and early signing in Chinese context.
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Affiliation(s)
- Rongrong Fan
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Siyu Yang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaofan Bu
- 12570Xiangya Nursing School of Central South University, Changsha, China
| | - Yongyi Chen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Ying Wang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Boyong Shen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Cuiling Qiu
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xuying Li
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
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Fernando GVMC, Nair SN. A Typical Perplexing Life-sustaining Therapy Decision at the End of life: A Case Report from Sri Lanka with Attributes Potentially worth Adopting from the UK Legislature. Indian J Palliat Care 2021; 27:345-348. [PMID: 34511806 PMCID: PMC8428901 DOI: 10.25259/ijpc_354_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/03/2021] [Indexed: 11/06/2022] Open
Abstract
In many developing parts of the world, evidence on advance care planning (ACP) is either lacking or fragmented. Lack of streamlined means for ACP is known to lead to inconveniences for the clinicians as well as the patients and their families. This case report focuses on a young male diagnosed with metastatic osteosarcoma, who explicitly verbalised his wishes to be managed conservatively without involving invasive life-sustaining measures. However, the patient faced cardiopulmonary resuscitation before his demise against his wishes, which also contradicted with the medical point of view. Sri Lankan doctors face moral, ethical and legal dilemmas as they deal with terminally ill patients at the verge of their death due to the deficiencies in the medical and legislative frameworks in the country.
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Affiliation(s)
- Gunasekara Vidana Mestrige Chamath Fernando
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka.,National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Sri Lanka
| | - Shoba Narayanan Nair
- Department of Pain and Palliative Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Ding CQ, Jin JF, Lan MJ, Zhang YP, Wang YW, Yang MF, Wang S. Do-not-resuscitate decision making for terminally ill older patients in the emergency department: An explorative, descriptive inquiry of Chinese family members. Geriatr Nurs 2021; 42:843-849. [PMID: 34090229 DOI: 10.1016/j.gerinurse.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Many terminally ill older adults depend on family members to make medical decisions in China. Many family members find it difficult to make do-not-resuscitate (DNR) decisions in emergency departments (ED). Currently, factors that affect DNR decision making by family members for older adults needing emergency care have not been well studied. This qualitative inquiry explores factors influencing DNR decision-making among family members of terminally ill older adults in ED. Semi-structured in-depth interviews were conducted for a 12-family member of terminally ill older adults at ED in China. Results of the conventional content analysis showed that family members made DNR decisions based on a wide of reasons: (a) subjective perception of family members, (b) conditions of the terminally ill older adults, (c) external environmental factors, and (d) internal family factors. The findings of this study expand our knowledge and understanding of factors influencing DNR decision-making by family members of terminally ill older adults in ED.
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Affiliation(s)
- Chuan-Qi Ding
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China; Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang Province, PR China
| | - Jing-Fen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China; Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang Province, PR China.
| | - Mei-Juan Lan
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Yu-Ping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Yu-Wei Wang
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Min-Fei Yang
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
| | - Sa Wang
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang Province, PR China
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Erath A, Shipley K, Walker LA, Burrell E, Weavind L. Code status at time of rapid response activation - Impact on escalation of care? Resusc Plus 2021; 6:100102. [PMID: 34223364 PMCID: PMC8244475 DOI: 10.1016/j.resplu.2021.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/23/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background A code status documents the decision to receive or forgo cardiopulmonary resuscitation in the event of cardiac arrest. For patients who undergo a rapid response team activation (RRT) for possible escalation to an intensive care unit (ICU), the presence or absence of a code status represents a critical inflection point for guiding care decisions and resource utilization. This study characterizes the prevalence of code status at the time of RRT and how code status at RRT affects rates of intensive treatments in the ICU. Methods We conducted a single-center retrospective cohort study of 895 rapid response activations occurring over six months. The study included all rapid response team activations for non-obstetric adult inpatients documented in the patient chart. All data was obtained through retrospective chart review. STROBE reporting guidelines were followed. Results At the time of RRT activation, 56% of patients had a documented code status. Code status prevalence was much higher among medical rather than surgical services (74% vs. 13%). For patients escalated to the ICU, having a DNR code status at RRT was not associated with decreased odds of receiving cardioactive medications or advanced respiratory support. Before RRT activation, palliative care utilization was low (9%) but more than doubled after RRT (24% before discharge). Conclusions Barely half of the patients had an active code status at the time of RRT activation. Similar rates of invasive ICU treatments among full code and DNR patients suggest that documented code statuses do not reflect in-depth goals of care discussions, nor does it guide medical teams caring for the patient at times of decompensation.
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Affiliation(s)
- Alexandra Erath
- School of Medicine, Vanderbilt University, Nashville, TN, United States
| | - Kipp Shipley
- Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Erin Burrell
- Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Liza Weavind
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, United States
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Wen FH, Chen CH, Chou WC, Chen JS, Chang WC, Hsieh CH, Tang ST. Evaluating if an Advance Care Planning Intervention Promotes Do-Not-Resuscitate Orders by Facilitating Accurate Prognostic Awareness. J Natl Compr Canc Netw 2020; 18:1658-1666. [PMID: 33285517 DOI: 10.6004/jnccn.2020.7601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Issuing do-not-resuscitate (DNR) orders has seldom been an outcome in randomized clinical trials of advance care planning (ACP) interventions. The aim of this study was to examine whether an ACP intervention facilitating accurate prognostic awareness (PA) for patients with advanced cancer was associated with earlier use of DNR orders. PATIENTS AND METHODS Participants (n=460) were randomly assigned 1:1 to the experimental and control arms, with 392 deceased participants constituting the final sample of this secondary analysis study. Participants in the intervention and control arms had each received an intervention tailored to their readiness for ACP/prognostic information and symptom-management education, respectively. Effectiveness in promoting a DNR order by facilitating accurate PA was determined by intention-to-treat analysis using multivariate logistic regression with hierarchical linear modeling. RESULTS At enrollment in the ACP intervention and before death, 9 (4.6%) and 8 (4.1%) participants and 168 (85.7%) and 164 (83.7%) participants in the experimental and control arms, respectively, had issued a DNR order, without significant between-arm differences. However, participants in the experimental arm with accurate PA were significantly more likely than participants in the control arm without accurate PA to have issued a DNR order before death (adjusted odds ratio, 2.264; 95% CI, 1.036-4.951; P=.041). Specifically, participants in the experimental arm who first reported accurate PA 31 to 90 days before death were significantly more likely than their counterparts in the control arm who reported accurate PA to have issued a DNR order in the next wave of assessment (adjusted odds ratio, 13.365; 95% CI, 1.989-89.786; P=.008). Both arms issued DNR orders close to death (median, 5-6 days before death). CONCLUSIONS Our ACP intervention did not promote the overall presence of a DNR order. However, our intervention facilitated the issuance of NDR orders before death among patients with accurate PA, especially those who reported accurate PA 31 to 90 days before death, but it did not facilitate the issuance of DNR orders earlier than their counterparts in the control arm.ClinicalTrial.gov Identification: NCT01912846.
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Affiliation(s)
- Fur-Hsing Wen
- 1Department of International Business, Soochow University, and
| | - Chen Hsiu Chen
- 2School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Wen-Chi Chou
- 3Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,4Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- 3Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,4Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- 3Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,4Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- 3Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,4Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- 3Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,5Chang Gung University, School of Nursing, Tao-Yuan, Taiwan, ROC; and.,6Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung City, Taiwan, ROC
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Ding CQ, Zhang YP, Wang YW, Yang MF, Wang S, Cui NQ, Jin JF. Death and do-not-resuscitate order in the emergency department: A single-center three-year retrospective study in the Chinese mainland. World J Emerg Med 2020; 11:231-237. [PMID: 33014219 DOI: 10.5847/wjem.j.1920-8642.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS There were 214 patients' deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients' deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors influenced the family surrogates' decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confidence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) ≥72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation.
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Affiliation(s)
- Chuan-Qi Ding
- Department of Nursing, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Ping Zhang
- Department of Nursing, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Wei Wang
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Min-Fei Yang
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Sa Wang
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nian-Qi Cui
- Department of Nursing, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing-Fen Jin
- Department of Nursing, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Madadin M, Alsaffar GM, AlEssa SM, Khan A, Badghaish DA, Algarni SM, Menezes RG. Clinicians' Attitudes Towards Do-Not-Resuscitate Directives in a Teaching Hospital in Saudi Arabia. Cureus 2019; 11:e6510. [PMID: 31903316 PMCID: PMC6937465 DOI: 10.7759/cureus.6510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Do-Not-Resuscitate (DNR) directive has provided a major leap in end-of-life care. To demonstrate the factors influencing physicians' DNR decisions in King Fahd University Hospital in the Eastern Province of Saudi Arabia, 42 physicians from the medical and surgical departments of the same center were requested to participate in a cross-sectional survey. Thirty-six questionnaires were completed and returned from a total of 42 distributed among physicians, making a response rate of 85.7%. Certain diagnostic categories increase the likelihood of issuing a DNR order for a patient. Neurological (58.3%) and cardiovascular (41.7%) diseases were the highest response among other diseases in influencing physicians' decisions. In addition, other factors like lack of comorbidities (55.5%), age (52.7%), and previous intensive care unit (ICU) admissions and resuscitation (44.4%) showed an effect on the directive decisions of DNR among investigated physicians. However, weak palliative care in the hospital (11.1%), religious beliefs (5.5%), and gender (2.7%) were the least associated factors affecting physicians' DNR decisions. This study addresses the influencing factors of DNR orders issuance among King Fahd Hospital of the University physicians. Physicians noted that cultural standards and religious beliefs do play a role in their decision-making but had less of an effect as compared to other clinical data such as comorbidities, age, and previous ICU admissions.
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Affiliation(s)
- Mohammed Madadin
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Gada M Alsaffar
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Sara M AlEssa
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Afnan Khan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Dania A Badghaish
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Shahad M Algarni
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Advance Directive Preferences Among Terminally Ill Older Patients and Its Facilitators and Barriers in China: A Scoping Review. J Am Med Dir Assoc 2019; 20:1356-1361.e2. [DOI: 10.1016/j.jamda.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/05/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
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