Asian Oncol Nurs.  2020 Mar;20(1):10-19. 10.5388/aon.2020.20.1.10.

Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards

• Song N
• Choi JY

• KMID: 2507432
• DOI: http://doi.org/10.5388/aon.2020.20.1.10

Abstract

Purpose
This was a descriptive study to compare the characteristics and outcomes among deceased cancer patients that had do-notattempt-resuscitation (DNAR) agreements in hospice and oncology wards.
Methods
Subjects of this study were 250 patients with terminal cancer who died after making DNAR agreements from January 1, 2015 to December 31, 2016 . The subjects were divided into two groups those that died in hospice (n=150) and those that died in oncology wards (n=100). Data were collected from August 2017 to February 2018. Two trained investigators independently reviewed the medical records for subjects using survey tools developed by the researchers (r=.81).
Results
Among the general characteristics between two groups, there were differences in age (t=-2.54, p=.012) and education (χ²=5.96, p=.015). Among the disease related characteristics, there were differences in surgery history (χ²=10.09, p=.001), chemotherapy history (χ²=11.08, p=.002) and symptoms (t=5.14, p<.001) between the two groups. Among the treatment related characteristics, there were differences in chemotherapy at death (χ²=9.61, p=.002), radiotherapy at death (χ²=5.60, p=.018) and cardiopulmonary resuscitation (χ²=6.15, p=.029) between the two groups. Among nursing related characteristics, there was a difference in the frequency of nursing intervention after DNAR consent (t=3.72, p<.001) between the two groups. Among outcomes related characteristics, there were differences in consciousness state at the DNAR consent (χ²=64.82, p<.001), self-written consent (χ²=18.26, p=.001), hospitalization days (t=2.31, p=.022) and the cost per day of hospitalization (t=-4.81, p<.001) between the two groups.
Conclusion
This study found that the patients, families, and medical staff need to change their perception of hospice and palliative care to prevent medical expenses from rising due to unnecessary life-support treatment while preparing for death with family members.

Keyword

Hospice; Life support care; Resuscitation orders; Hospital cost; Hospitalizations