Yi-Hsin Liang1,2,3, Chih-Hsin Wei1, Wen-Hui Hsu4, Yu-Yun Shao2,3, Ya-Chin Lin4, Pei-Chun Chou4, Ann-Lii Cheng2,3,5,6, Kun-Huei Yeh7,8,9,10,11. 1. Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10002, Taiwan. 2. Department of Oncology, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. 3. Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan. 4. Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan. 5. Department of Internal Medicine, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. 6. Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. 7. Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10002, Taiwan. khyeh@ntu.edu.tw. 8. Department of Oncology, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. khyeh@ntu.edu.tw. 9. Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan. khyeh@ntu.edu.tw. 10. Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. khyeh@ntu.edu.tw. 11. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan. khyeh@ntu.edu.tw.
Abstract
PURPOSE: Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. METHODS: This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups. RESULTS: We enrolled 1495 patients. The most prevalent primary cancers were hepato-biliary-pancreatic (26.9 %), lung (16.3 %), and colorectal (14.0 %) cancers. We classified 965 (64.5 %) and 530 (35.5 %) patients into the DNR-S and DNR-P groups, respectively. Significant differences were observed between both groups regarding gender (p = 0.002), age (p < 0.001), and the Eastern Cooperative Oncology Group performance (p < 0.001) and educational (p < 0.001) status levels. The median survival times after DNR consent signature were 5.0 days (95 % confidence interval [CI] 4.4-5.6 days) and 14.0 days (95 % CI 12.1-15.9 days) in the DNR-S and DNR-P groups, respectively (p < 0.001). The median good death evaluation (GDE) scores were 5.4 (95 % CI 4.9-6.0) and 13.7 (95 % CI 12.7-14.6) in the DNR-S and DNR-P groups, respectively (p < 0.001). Univariate and multivariate analyses revealed that DNR-S was an independent factor for significantly low GDE scores (i.e., poor EOL care quality). CONCLUSION: The DNR concept is emerging; however, the DNR-P percentage remains low (35.6 %) in patients with advanced cancer. DNR-P significantly improves the EOL care quality.
PURPOSE: Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. METHODS: This retrospective study enrolled advanced cancerpatients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups. RESULTS: We enrolled 1495 patients. The most prevalent primary cancers were hepato-biliary-pancreatic (26.9 %), lung (16.3 %), and colorectal (14.0 %) cancers. We classified 965 (64.5 %) and 530 (35.5 %) patients into the DNR-S and DNR-P groups, respectively. Significant differences were observed between both groups regarding gender (p = 0.002), age (p < 0.001), and the Eastern Cooperative Oncology Group performance (p < 0.001) and educational (p < 0.001) status levels. The median survival times after DNR consent signature were 5.0 days (95 % confidence interval [CI] 4.4-5.6 days) and 14.0 days (95 % CI 12.1-15.9 days) in the DNR-S and DNR-P groups, respectively (p < 0.001). The median good death evaluation (GDE) scores were 5.4 (95 % CI 4.9-6.0) and 13.7 (95 % CI 12.7-14.6) in the DNR-S and DNR-P groups, respectively (p < 0.001). Univariate and multivariate analyses revealed that DNR-S was an independent factor for significantly low GDE scores (i.e., poor EOL care quality). CONCLUSION: The DNR concept is emerging; however, the DNR-P percentage remains low (35.6 %) in patients with advanced cancer. DNR-P significantly improves the EOL care quality.
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
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