Factors determining the establishment of DNR orders in oncologic patients at a university hospital in Korea

Song, Taejun; Kim, Kyupyo; Koh, Younsuck

Abstract

BACKGROUND/AIMS: Do-Not-Resuscitate (DNR) orders have been one of the critical issues considered in futile medical management, but they have not been legally defined in Korea. The aim of this study was to observe the factors that influence DNR agreement and to determine the current status of DNR orders in the hemato-oncology wards of a university hospital, in which DNR orders were formally implemented through the Hospital Ethics Committee in October 2001.
METHODS
We retrospectively analyzed the records of 213 patients who had died in the hemato-oncology department at a university hospital between January 2002 and July 2002.
RESULTS
Of the 213 patients, 181 (85%) agreed to a DNR order. Cardiopulmonary resuscitation was done in 1 out of 181 patients. The DNRs were suggested by attending physicians in 83.9% of cases and by family members in 16.1%. The patients with more frequent admission to the hospital (3.7+/-2.6 vs. 2.9+/-1.7, p<0.05) and with higher educational level (p<0.05) were more likely to agree to a DNR order. Patients with gastrointestinal tract cancer were more likely to agree to a DNR order than patients with lung cancer or hematologic malignancy (p<0.05). The levels of care after DNR agreement were: withholding of resuscitation only (17.2%), withholding of additional support (73.9%), and active withdrawal of provided support (8.9%).
CONCLUSIONS
The frequency of admission, type of malignancy, and educational level of patients were determining factors for the establishment of DNR orders in patients with malignancy.