Cancer Res Treat.  2017 Apr;49(2):502-508. 10.4143/crt.2016.073.

The Association between End-of-Life Care and the Time Interval between Provision of a Do-Not-Resuscitate Consent and Death in Cancer Patients in Korea

• Baek SK
• Chang HJ
• Byun JM
• Han JJ
• Heo DS

• KMID: 2378123
• DOI: http://doi.org/10.4143/crt.2016.073

Abstract

PURPOSE
We explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea.
MATERIALS AND METHODS
A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days).
RESULTS
In general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001).
CONCLUSION
Earlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.

Keyword

Neoplasms; Resuscitation orders; Terminal care

MeSH Terms

Cardiopulmonary Resuscitation
Health Care Costs
Humans
Intubation
Korea*
Resuscitation Orders
Retrospective Studies
Terminal Care

Figure

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  Fig. 1. Less aggressive intervention score (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests) according to group (based on time interval between the DNR consent and death). DNR, do-not-resuscitate; EOL, end-of-life.

Reference

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