Do-not-resuscitate consent signed by patients indicates a more favorable quality of end-of-life care for patients with advanced cancer
Journal
Support Care Cancer
Journal Volume
25
Journal Issue
2
Date Issued
2017
Author(s)
Abstract
© 2016, Springer-Verlag Berlin Heidelberg. Purpose: Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. Methods: This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups. Results: We enrolled 1495 patients. The most prevalent primary cancers were hepato-biliary-pancreatic (26.9 %), lung (16.3 %), and colorectal (14.0 %) cancers. We classified 965 (64.5 %) and 530 (35.5 %) patients into the DNR-S and DNR-P groups, respectively. Significant differences were observed between both groups regarding gender (p = 0.002), age (p < 0.001), and the Eastern Cooperative Oncology Group performance (p < 0.001) and educational (p < 0.001) status levels. The median survival times after DNR consent signature were 5.0 days (95 % confidence interval [CI] 4.4–5.6 days) and 14.0 days (95 % CI 12.1–15.9 days) in the DNR-S and DNR-P groups, respectively (p < 0.001). The median good death evaluation (GDE) scores were 5.4 (95 % CI 4.9–6.0) and 13.7 (95 % CI 12.7–14.6) in the DNR-S and DNR-P groups, respectively (p < 0.001). Univariate and multivariate analyses revealed that DNR-S was an independent factor for significantly low GDE scores (i.e., poor EOL care quality). Conclusion: The DNR concept is emerging; however, the DNR-P percentage remains low (35.6 %) in patients with advanced cancer. DNR-P significantly improves the EOL care quality.
Subjects
Advanced cancer | Do-not-resuscitate | End-of-life care | Terminal
Advanced cancer; Do-not-resuscitate; End-of-life care; Terminal
SDGs
Other Subjects
adolescent; adult; advanced cancer; aged; Article; cancer mortality; cancer patient; cancer survival; child; colorectal cancer; digestive system cancer; do not resuscitate consent; educational status; female; good death evaluation score; health care quality; hepatobiliary system cancer; human; informed consent; lung cancer; major clinical study; male; median survival time; pancreas cancer; patient autonomy; primary tumor; priority journal; retrospective study; scoring system; self concept; sex difference; terminal care; ethics; hospice care; middle aged; Neoplasms; procedures; resuscitation; terminal care; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Hospice Care; Humans; Male; Middle Aged; Neoplasms; Resuscitation Orders; Retrospective Studies; Terminal Care; Young Adult
Type
journal article