Korean J Hosp Palliat Care.  2018 Jun;21(2):51-57. 10.14475/kjhpc.2018.21.2.51.

End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience

• Yoon SE
• Nam EM
• Lee SN

• KMID: 2412942
• DOI: http://doi.org/10.14475/kjhpc.2018.21.2.51

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

MeSH Terms

Advance Care Planning
Cause of Death
Central Nervous System
Critical Care
Decision Making
Humans
Medical Records
Resuscitation Orders*
Retrospective Studies
Terminal Care
Ventilators, Mechanical