YI-HSIN LIANGWei, C. H.C. H.WeiHsu, W. H.W. H.HsuYU-YUN SHAOLin, Y. C.Y. C.LinChou, P. C.P. C.ChouANN-LII CHENGKUN-HUEI YEH2020-04-092020-04-0920170941-43551433-7339https://scholars.lib.ntu.edu.tw/handle/123456789/484031© 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.Advanced cancer | Do-not-resuscitate | End-of-life care | TerminalAdvanced cancer; Do-not-resuscitate; End-of-life care; Terminal[SDGs]SDG3adolescent; 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 Adultjournal article10.1007/s00520-016-3434-535859490277042612-s2.0-84990948178https://www.ncbi.nlm.nih.gov/pubmed/2770426135859490