Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department

Cheng, Ya Hui; Wang, Jing Jy; Wu, Kuan Han; Huang, Shan; Kuo, Mei Ling; Su, Chao Hui

doi:10.1007/s00520-015-2971-7

Cited by 19 publications

(21 citation statements)

References 38 publications

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“…As mentioned above, the most important reasons to self-refer to an ED were health concerns and further examinations. [34] ED LOS was a predictive factor for the DNR decision, which was similar to the result of the study by Cheng et al [11] Patients whose family surrogates signed a DNR order tended to stay longer at the ED and increased overcrowding. [22] These DNR patients with more complex comorbidities and terminal illnesses were more likely to die in the ED; this is a questionable development as the ED is not the most appropriate place for adequate end-of-life care, which should take place in a quiet and peaceful area.…”

Section: Discussionsupporting

confidence: 85%

“…Emergency departments (EDs) provide physical and psychological treatments for patients with severe diseases or terminal illnesses. [11,12] Death frequently occurs in EDs. [13] Recent evidence indicates that half of the elderly patients visited the emergency room in the last month of their lives.…”

Section: Introductionmentioning

confidence: 99%

“…Life-sustaining active treatments are sometimes regarded as futile for those with incurable or terminal illness, although they may prolong the patient's lives. [11,16] Patients consenting to DNR were often able to avoid futile examination and invasive rescue measures, to alleviate suffering and maintain their dignity. [17] Signing a DNR consent form is an important medical decision-making process; early initiation of discussions can improve end-of-life care and reduce futile treatments in EDs.…”

Section: Introductionmentioning

confidence: 99%

“…[17] Signing a DNR consent form is an important medical decision-making process; early initiation of discussions can improve end-of-life care and reduce futile treatments in EDs. [11] In China, many families object to revealing about an incurable diagnosis or poor disease prognosis to patients, which may impede the end-of-life care-related decisions. Studies show that Chinese patients may leave their end-of-life care-related decisions, such as receiving life-sustaining therapy or signing DNR directives, to family members.…”

Section: Introductionmentioning

confidence: 99%

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Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

et al. 2020

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BACKGROUND: Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS: This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS: There were 214 patients' deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients' deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors infl uenced the family surrogates' decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confi dence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) ≥72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS: In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

et al. 2020

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“…The DNR decision-making process varies in different countries and among countries 1,16 .The difference of opinion in belief, acceptance, acknowledgment and approval with regards to performance, morality and legality have been observed in different societies, cultures, ethnicities and religions [5][6][7][8][9][10][11][12][13][14][15][16][17]18 .…”

Section: Decision-making In Dnrmentioning

confidence: 99%

Do-Not-Resuscitate (DNR)

Piryani

2018

J. Kathmandu Med. Coll.

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Do-Not-Resuscitate (DNR) is well conceptualized, understood and implemented in developed countries in comparison to developing countries. DNR, DNAR (Do-Not-Attempt-Resuscitation), and AND (Allow-Natural-Death) are the same instructions or orders with an equal meaning. DNR is a therapeutic decision made before incident of cardiac or respiratory (cardiopulmonary) arrest with the consent of patient, or proxy consent of next of kin or authorized person if patient is not competent and sound. In this case, healthcare professionals provide no requisite CPR (Cardiopulmonary Resuscitation) without stopping any degree of normal care and therapy given to the patient. It is essential to consider who should discuss the DNR status and with whom, what and when it should be discussed, how should discussion be done and documented and who shall sign the DNR consent. Documentation in the patient’s medical record of a decision with regard to DNR and not to perform CPR must be incorporated both in clinician’s order and in the progress notes of the patient. The Nepal Medical Council’s guidelines for DNR are very clear and well spelt out but the implementation process is not documented. Healthcare decision must be taken on ethical ground besides clinical and technical ground. Healthcare professionals must be trained to become ethically competent. To effectively use and prevent misuse of DNR order, health professional must be educated about DNR.

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Timing of do-not-resuscitate orders and health care utilization near the end of life in cancer patients: a retrospective cohort study

Cui

Ping

Wang

et al. 2020

Support Care Cancer

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Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department

Cited by 19 publications

References 38 publications

Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

Do-Not-Resuscitate (DNR)

Timing of do-not-resuscitate orders and health care utilization near the end of life in cancer patients: a retrospective cohort study

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