Evaluation of end of life care in cancer patients at a teaching hospital in Japan

Abstract

Objectives: To analyse the decision making for end of life care for patients with cancer at a teaching hospital in Japan at two periods 10 years apart. Design and setting: Retrospective study conducted in a 550 bed community teaching hospital in Okinawa, Japan. Patients: There were 124 terminally ill cancer patients (45 women; 79 men; median age, 69 years) admitted either in 1989 and 1999 for end of life care with sufficient data to permit analysis. Main measurements: Basic demographic data, notification to the patient that he or she had cancer, patient involvement in do not resuscitate (DNR) orders, and various medical interventions which were performed in the month prior to the patient's death were evaluated. Results: In 1989 none of the patients were notified of their diagnosis; in 1999 five patients were informed (p = 0.026). Of the 113 (91%) patients with a written DNR order, none were involved in consenting to the DNR order. In the month before death, patients in both groups received non-palliative treatments such as feeding tube placements (five in 1989; five in 1999), total parenteral nutrition (six in 1989; eight in 1999), and intravenous albumin infusion (four in 1989; five in 1999). Morphine use increased (30%) significantly in 1999 compared with the 1989 group. Conclusions: The majority of patients dying of cancer were still not informed of their diagnosis and were seldom involved in DNR decision making at a teaching hospital in Japan. There was no change in the number of potentially futile interventions that were performed (6-13%) but morphine use increased. Modern ethical education is urgently needed in Japanese medical practice to improve decision making process in the end of life care.

CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience

“…A similar trend is also seen in other Asian countries. For example, according to Tokuda et al [15], most Japanese cancer patients are seldom involved in DNR decision making at a teaching hospital. According to Liu et al [16], while DNR orders are written for 64.4% of Chinese terminal cancer patients, the order is seldom personally signed by the patient.…”

Quality of end-of-life treatment for cancer patients in general wards and the palliative care unit at a regional cancer center in Japan: a retrospective chart review

“…This is also the case with Western countries. Previous studies investigated some aspects of quality of end-of-life care in Japan as follows: satisfaction of end-of-life care for cancer patients who died in PCUs [18], the efficacy of PCTs [19,20], documentation of DNR orders in a teaching hospital [21], treatments and status of disclosure in the last 48 h of life in PCU and those provided in a geriatric hospital, where 42% of patients had cancer [22]. It is unclear who actually consents to DNR; however, in Japan, a cultural feature is that the family plays a greater role in this type of decision making [23][24][25].…”

‘Do not resuscitate’ decisions in continuing care psychiatric patients: what influences decisions?

“…A 'do not resuscitate' (DNR) decision entails complex medical, legal and ethical issues (Levin & Levin, 1980;Cotler, 2000;Cowper, 2000;Murphy, 2002;Thomas, 2002;Vetsch et al, 2002;Berger, 2003;Hartley, 2004). The effectiveness of cardiopulmonary resuscitation (CPR) varies according to the nature of the underlying clinical condition (Dautzenberg et al, 1993).…”

“…Most studies on DNR decisions considered physically ill patients in whom CPR would have probably been unsuccessful (Beach & Morrison, 2002;Jackson et al, 2004;Hemphill et al, 2004;Tokuda et al, 2004). A number have explored ethical issues in the paediatric population (Klopfenstein et al, 2001;Da Costa et al, 2002).…”