KMID : 0856920180210020051
|
|
Journal of Hospice and Palliative Care 2018 Volume.21 No. 2 p.51 ~ p.57
|
|
End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience
|
|
Yoon Sang-Eun
Nam Eun-Mi Lee Soon-Nam
|
|
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.
|
|
KEYWORD
|
|
Resuscitation orders, Decision making, Advance care planning, Terminal care
|
|
FullTexts / Linksout information
|
|
|
|
Listed journal information
|
|
|