The Association between End-of-Life Care and the Time Interval between Provision of a Do-Not-Resuscitate Consent and Death in Cancer Patients in Korea

Abstract

PurposeWe explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea.Materials and MethodsA total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days).ResultsIn general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001).ConclusionEarlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.

Can Primary palliative care education change life-sustaining treatment intensity of older adults at the end of life? A retrospective study

“…and 68.1% in the two groups, which was higher than another study [17]. It suggested high prevalence of dysphagia at the EOL in older adults.…”

“…Prognostication involves 3 key components: formulation of the patient's prognosis; communication of the patient's prognosis; and the patient or surrogate's interpretation of the communicated prognosis [18]. A study [17] had shown that early DNR consent can reduce the CPR attempt and other invasive treatments in patients with advanced cancer. The patients are more willing to accept a DNR decision when it was referred to as 'allowing natural death', when there is comprehensive information and when there are worse outcomes [19].…”

The Effect of Hospice Consultation on Aggressive Treatment of Lung Cancer

“…In Korea, DNR documentation is usually obtained only when death is very imminent. In previous studies of DNR documentation by Korean cancer patients [ 27 , 28 ], the median time interval from DNR consent to death ranges from 1.76 to 6 days, which was shorter than that reported in the United States [ 29 ]. This short time does not permit enough opportunity to elicit personal value and goals, to contemplate options, and to clarify preferences for treatment.…”

Difficulties doctors experience during life-sustaining treatment discussion after enactment of the Life-Sustaining Treatment Decisions Act: A cross-sectional study

“…Decisions for LST in Korea are mostly discussed within a few days or weeks before death (4)(5)(6). Family members usually write a do-not-resuscitate document as surrogate decision makers for family members near death (5)(6)(7)(8). Furthermore, patients in the terminal stage are more likely to receive aggressive treatment with little curative effect (9)(10)(11).…”