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Mirhosseini S, Aghayan SS, Basirinezhad MH, Ebrahimi H. Health Care Providers' Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:908-918. [PMID: 35042392 PMCID: PMC8792911 DOI: 10.1177/00302228211057992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to investigate the health care providers' attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients.
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Affiliation(s)
- Seyedmohammad Mirhosseini
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Shahrokh Aghayan
- Department of Clinical Sciences, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Fereidouni A, Rassouli M, Karami M, Pakseresht M, Barasteh S. Preferred place of death challenges the allocation of health resources in Iran. Int J Palliat Nurs 2023; 29:553-554. [PMID: 38039122 DOI: 10.12968/ijpn.2023.29.11.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Affiliation(s)
- Armin Fereidouni
- Medicine Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Iran
| | - Maryam Karami
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Iran
| | - Maryam Pakseresht
- School of Nursing and Midwifery Ilam University of Medical Science, Ilam, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty of Baqiyatallah University of Medical Sciences, Iran
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Dinkelbach L, Galushko M, Oommen-Halbach A, Felek M, Dechert O, Trocan L, Janßen G. Advance care planning and the parental geographical background in pediatric palliative home care: a retrospective chart review. Eur J Pediatr 2022; 181:2789-2797. [PMID: 35507218 PMCID: PMC9192398 DOI: 10.1007/s00431-022-04469-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
The relevance to acknowledge the parental migration history in pediatric palliative care is widely recognized. However, its influence on integral parts of advance care planning (ACP) is unknown. In this non-interventional cohort study, we aimed at identifying systematic differences between pediatric palliative patients with varying parental countries of origin regarding medical orders for life-sustaining treatment and the location of patients' death. Two hundred eighty-eight pediatric cases in an ambulant pediatric palliative care setting in Germany were retrospectively analyzed using multinomial logistic regression models. Agreements on medical orders for life-sustaining treatment (MOLST) differed significantly between patients with varying parental countries of origin. Full code orders for life-sustaining treatment were made more often in Turkish families than in German families. There were no significant associations between the patients' location of death and the parental countries of origin. However, confounder-analysis revealed a strong association between the patients' underlying disease and the orders for life-sustaining treatment as well as the location of death.Conclusions: Even this study indicates that the parental geographical background as an important sociocultural aspect might have an impact on ACP decisions for children and adolescents with life-limiting conditions, other factors as the patients' underlying disease can be more crucial for decision making in pediatric palliative care. The reason for the differences found might lay in cultural preferences or barriers to appropriate care. The inclusion of sociocultural aspects in decision-making is crucial to guarantee culture-sensitive, patient-centered pediatric palliative care.
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Affiliation(s)
- Lars Dinkelbach
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany. .,Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.
| | - Maren Galushko
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Anne Oommen-Halbach
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Melisa Felek
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Oliver Dechert
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Laura Trocan
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Gisela Janßen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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Lin HM, Liu CK, Huang YC, Ho CW, Chen M. Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010428. [PMID: 35010693 PMCID: PMC8744657 DOI: 10.3390/ijerph19010428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/21/2022]
Abstract
Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.
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Affiliation(s)
- Hui-Mei Lin
- Taipei City Hospital, RenAi Branch Nursing Supervisor, Taipei 106, Taiwan;
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
| | - Chih-Kuang Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Yen-Chun Huang
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Chieh-Wen Ho
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Life Science, National Taiwan University, Taipei 106, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Correspondence:
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Safari Malak-Kolaei F, Sanagoo A, Pahlavanzadeh B, Akrami F, Jouybari L, Jahanshahi R. The Relationship Between Death and Do Not Resuscitation Attitudes Among Intensive Care Nurses. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:904-914. [PMID: 32938307 DOI: 10.1177/0030222820959235] [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: 11/17/2022]
Abstract
This study aimed to determine the relationship between death and DNR attitudes among ICNs. This descriptive-analytical study was performed on 156 ICNs in 2018. All nurses were enrolled in the study; data collection instruments included Death Attitude Profile-Revised (DAP-R) and the DNR attitude questionnaires. The mean scores of DAP-R and DNR items were 150.89/ ± 23.59 and 91.82 ± 11.41, respectively. There was a significant relationship between death attitude and DNR attitude Famong ICNs. All dimensions of DAP-R significantly predicted attitude toward DNR (P < 0.05). Among those, "neutral acceptance" (1.17 [95% CI (0.68--1.65)] was the strongest predictor and "death avoidance" was the weakest predictor (0.36 [95% CI (0.09--0.62)]. There was a significant relationship between the ICNs' work experience and attitude toward DNR (p = 0.03). The findings can be used in formulation of the national guideline for DNR order.
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Affiliation(s)
| | - Akram Sanagoo
- Education Development Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Bagher Pahlavanzadeh
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Forouzan Akrami
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Jouybari
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Jahanshahi
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
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