PURPOSE: The aim of the study was to compare timing and decision-makers of do-not-resuscitate (DNR) orders between patients with end-stage thoracic cancer and non-cancer respiratory diseases in a Japanese acute care hospital. METHODS: This study retrospectively reviewed the medical records of patients who died between January 2008 and March 2013 in the Department of Respiratory Medicine of Osaka Police Hospital, a teaching and acute care hospital. We compared the decision-making process, especially timing and decision-maker, of DNR orders between patients with thoracic cancer and patients with non-cancer respiratory diseases. RESULTS: There were 300 cancer patients and 147 non-cancer patients. Cancer patients were significantly younger, were hospitalized more frequently and for longer, were more likely to have a DNR order placed earlier and decided in advance of last admission, and were more likely to have normal cognitive function at the time of the DNR order than non-cancer patients. Spouses of cancer patients were more likely to participate in DNR discussion. Only approximately 6 % of patients participated in DNR discussion in both groups. Cancer patients less frequently received aggressive treatment at the end of life (EOL) and were more likely to die in general wards than in intensive care units. CONCLUSIONS: Our study found that most Japanese patients, with or without cancer, who died in an acute care respiratory department, were not included in DNR discussions and that familial surrogates usually made the DNR decision at the EOL.
PURPOSE: The aim of the study was to compare timing and decision-makers of do-not-resuscitate (DNR) orders between patients with end-stage thoracic cancer and non-cancer respiratory diseases in a Japanese acute care hospital. METHODS: This study retrospectively reviewed the medical records of patients who died between January 2008 and March 2013 in the Department of Respiratory Medicine of Osaka Police Hospital, a teaching and acute care hospital. We compared the decision-making process, especially timing and decision-maker, of DNR orders between patients with thoracic cancer and patients with non-cancer respiratory diseases. RESULTS: There were 300 cancerpatients and 147 non-cancerpatients. Cancerpatients were significantly younger, were hospitalized more frequently and for longer, were more likely to have a DNR order placed earlier and decided in advance of last admission, and were more likely to have normal cognitive function at the time of the DNR order than non-cancerpatients. Spouses of cancerpatients were more likely to participate in DNR discussion. Only approximately 6 % of patients participated in DNR discussion in both groups. Cancerpatients less frequently received aggressive treatment at the end of life (EOL) and were more likely to die in general wards than in intensive care units. CONCLUSIONS: Our study found that most Japanese patients, with or without cancer, who died in an acute care respiratory department, were not included in DNR discussions and that familial surrogates usually made the DNR decision at the EOL.
Authors: Kam Shing Lau; Doris Man Wah Tse; Tracy Wai Tsan Chen; Po Tin Lam; Wai Man Lam; Kin Sang Chan Journal: J Pain Symptom Manage Date: 2010-08-21 Impact factor: 3.612
Authors: M T Claessens; J Lynn; Z Zhong; N A Desbiens; R S Phillips; A W Wu; F E Harrell; A F Connors Journal: J Am Geriatr Soc Date: 2000-05 Impact factor: 5.562
Authors: Rhea A Stein; Louise Sharpe; Melanie L Bell; Fran M Boyle; Stewart M Dunn; Stephen J Clarke Journal: J Clin Oncol Date: 2013-07-29 Impact factor: 44.544
Authors: Ju Won Kim; Jung Yoon Choi; Won Jin Jang; Yoon Ji Choi; Youn Seon Choi; Sang Won Shin; Yeul Hong Kim; Kyong Hwa Park Journal: BMC Palliat Care Date: 2019-10-22 Impact factor: 3.234