The association between the content of palliative family conferences and do-not-resuscitate decisions
Date Issued
2016
Date
2016
Author(s)
Chang, Ping-Hsun
Abstract
Since Dec 2012, Taiwan''s National Health Insurance started to cover palliative family conference, and formal meeting records were required for the payment package. In critical or terminal diseases, the communication between patients, their families and medical teams are often insufficient. Family meetings serve an important role in medical communication. But only few empirical studies exist for the famliy meetings in Taiwan. This is a retrospective cohort study. All family meeting payment package records in a medical center in northen Taiwan were collected from Dec 2014 to Nov 2015. 248 patients and their medical records, including variables of demographic data, diseae severity, participants and the content of the family meetings, and relevant medical interventions, were included. Multivariate logistic regression was performed to identify the association of these factors and the designation of Do-Not-Resuscitate (DNR) decisions. The association was tested in 7 days, 14 days, 30 days after the family meeting, and on May 31, 2015. The result showed that consulting a palliative team, high ECOG score during the meeting, disease in progression or imminent dying, distant metastasis, low lymphocyte percentage, more medical personnel attending the meeting, and believing in Buddism, Daoism or Taiwanese Folk Religion, were signinificantly and positively assosicated with DNR dicisions. Age, gender, using anti-cancer medication, the patient''s participation of the family meeting, and discussing about DNR during the meeting, showed no significant association. Taking antiiotics during the meeting and marital status were significant only within 2 days after a family meeting. Having male family members in the meeting also potentially influences the DNR decisions. We also analysed factors influencing a patient''s participation of a family meeting. The significantly associated variables were: age, gender, ECOG, number of participants, having male family members in the meeting, and discussing about DNR in the meeting.
Subjects
family conference
do-not-resuscitate
DNR
autonomy
terminal illness
palliative care
cancer
SDGs
Type
thesis
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