End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience.
10.14475/kjhpc.2018.21.2.51
- Author:
Sang Eun YOON
1
;
Eun Mi NAM
;
Soon Nam LEE
Author Information
1. Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea. enam34@ewha.ac.kr
- Publication Type:Original Article
- Keywords:
Resuscitation orders;
Decision making;
Advance care planning;
Terminal care
- MeSH:
Advance Care Planning;
Cause of Death;
Central Nervous System;
Critical Care;
Decision Making;
Humans;
Medical Records;
Resuscitation Orders*;
Retrospective Studies;
Terminal Care;
Ventilators, Mechanical
- From:Korean Journal of Hospice and Palliative Care
2018;21(2):51-57
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. METHODS: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. RESULTS: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P < 0.05). CONCLUSION: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.
