Skip to main content
SpringerLink
Log in

Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Paterick TJ, Carson GV, Allen MC, Paterick TE (2008) Medical informed consent: general considerations for physicians. Mayo Clin Proc 83(3):313–319

    Article  PubMed  Google Scholar 

  2. Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8(4):311–313

    Article  CAS  PubMed  Google Scholar 

  3. Nava S, Sturani C, Hartl S, Magni G, Ciontu M, Corrado A, Simonds A (2007) End-of-life decision-making in respiratory intermediate care units: a European survey. Eur Respir J 30(1):156–164

    Article  CAS  PubMed  Google Scholar 

  4. Seow H, Barbera L, Sutradhar R, Howell D, Dudgeon D, Atzema C, Liu Y, Husain A, Sussman J, Earle C (2011) Trajectory of performance status and symptom scores for patients with cancer during the last 6 months of life. J Clin Oncol 29(9):1151–1158

    Article  PubMed  Google Scholar 

  5. Hilden HM, Louhiala P, Palo J (2004) End of life decisions: attitudes of Finnish physicians. J Med Ethics 30(4):362–365

    Article  PubMed Central  PubMed  Google Scholar 

  6. Junod Perron N, Morabia A, De Torrente A (2002) Evaluation of do not resuscitate orders (DNR) in a Swiss community hospital. J Med Ethics 28(6):364–367

    Article  CAS  PubMed  Google Scholar 

  7. Ivo K, Younsuck K, Ho YY, Sang-Yeon S, Seog HD, Hyunah B, Kenji H, Xiaomei Z (2012) A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan. J Med Ethics 38(5):310–316

    Article  PubMed  Google Scholar 

  8. Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK (2006) CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Support Care Cancer 14(2):103–108

    Article  PubMed  Google Scholar 

  9. Voltz R, Akabayashi A, Reese C, Ohi G, Sass HM (1998) End-of-life decisions and advance directives in palliative care: a cross-cultural survey of patients and health-care professionals. J Pain Symptom Manage 16(3):153–162

    Article  CAS  PubMed  Google Scholar 

  10. Kizawa Y, Tsuneto S, Hamano J, Nagaoka H, Maeno T, Shima Y (2013) Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey. Am J Hosp Palliat Care 30(7):664–669

    Article  PubMed  Google Scholar 

  11. Kizawa Y, Tsuneto S, Hamano J, Nagaoka H, Maeno T, Shima Y (2012) Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey. Am J Hosp Palliat Care 30:664–669

    Article  PubMed  Google Scholar 

  12. Takezako Y, Ishikawa S, Kajii E (2013) Advance directives in Japanese nursing homes. J Pain Symptom Manage 45(1):63.e67–70.e67

    Article  Google Scholar 

  13. Miyashia M (2013) White paper of hospice and palliative care 2013. Japan Hospice Palliative Care Foundation, Osaka, pp 55–69 (in Japanese)

    Google Scholar 

  14. Japan Ministry of Health, Labour and Welfare (2012) Vital statistics of Japan 2011. Volume 1: General mortality. Table 5.5: Trends in deaths by place of occurrence: Japan

  15. Nakano K, Yoshida T, Furutama J, Sunada S (2012) Quality of end-of-life care for patients with metastatic non-small-cell lung cancer in general wards and palliative care units in Japan. Support Care Cancer 20(4):883–888

    Article  PubMed  Google Scholar 

  16. Sato K, Miyashita M, Morita T, Sanjo M, Shima Y, Uchitomi Y (2008) 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. Support Care Cancer 16(2):113–122

    Article  CAS  PubMed  Google Scholar 

  17. Chou WC, Lai YT, Huang YC, Chang CL, Wu WS, Hung YS (2013) Comparing end-of-life care for hospitalized patients with chronic obstructive pulmonary disease and lung cancer in Taiwan. J Palliat Care 29(1):29–35

    PubMed  Google Scholar 

  18. Au DH, Udris EM, Fihn SD, McDonell MB, Curtis JR (2006) Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med 166(3):326–331

    Article  PubMed  Google Scholar 

  19. Claessens MT, Lynn J, Zhong Z, Desbiens NA, Phillips RS, Wu AW, Harrell FE Jr, Connors AF Jr (2000) Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 48(5 Suppl):S146–S153

    CAS  PubMed  Google Scholar 

  20. Edmonds P, Karlsen S, Khan S, Addington-Hall J (2001) A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer. Palliat Med 15(4):287–295

    Article  CAS  PubMed  Google Scholar 

  21. Goodridge D, Lawson J, Duggleby W, Marciniuk D, Rennie D, Stang M (2008) Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life. Respir Med 102(6):885–891

    Article  PubMed  Google Scholar 

  22. Gore JM, Brophy CJ, Greenstone MA (2000) How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax 55(12):1000–1006

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Cohen J (1992) A power primer. Psychol Bull 112(1):155–159

    Article  CAS  PubMed  Google Scholar 

  24. Kazis LE, Anderson JJ, Meenan RF (1989) Effect sizes for interpreting changes in health status. Med Care 27(3 Suppl):S178–S189

    Article  CAS  PubMed  Google Scholar 

  25. Cohen J (1977) Chi-square tests for goodness of fit and contingency tables. Statistical power analyses for the behavioral sciences. Academic Press, Inc., Orlando, pp 215–271

  26. Cohen J (1988) Statistical power analysis for the behavioural sciences. Lawrence Erlbaum Associates, Mahwah

    Google Scholar 

  27. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Kim do Y, Lee KE, Nam EM, Lee HR, Lee KW, Kim JH, Lee JS, Lee SN (2007) Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea. J Palliat Med 10(5):1153–1158

    Article  PubMed  Google Scholar 

  29. Wen KY, Lin YC, Cheng JF, Chou PC, Wei CH, Chen YF, Sun JL (2013) Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients. Support Care Cancer 21:2593–2598

    Article  PubMed Central  PubMed  Google Scholar 

  30. Huang CH, Hu WY, Chiu TY, Chen CY (2008) The practicalities of terminally ill patients signing their own DNR orders—a study in Taiwan. J Med Ethics 34(5):336–340

    Article  PubMed  Google Scholar 

  31. Lau KS, Tse DM, Tsan Chen TW, Lam PT, Lam WM, Chan KS (2010) Comparing noncancer and cancer deaths in Hong Kong: a retrospective review. J Pain Symptom Manage 40(5):704–714

    Article  PubMed  Google Scholar 

  32. Torke AM, Sachs GA, Helft PR, Petronio S, Purnell C, Hui S, Callahan CM (2011) Timing of do-not-resuscitate orders for hospitalized older adults who require a surrogate decision-maker. J Am Geriatr Soc 59(7):1326–1331

    Article  PubMed Central  PubMed  Google Scholar 

  33. Levin TT, Li Y, Weiner JS, Lewis F, Bartell A, Piercy J, Kissane DW (2008) How do-not-resuscitate orders are utilized in cancer patients: timing relative to death and communication-training implications. Palliat Support Care 6(4):341–348

    Article  PubMed  Google Scholar 

  34. Stein RA, Sharpe L, Bell ML, Boyle FM, Dunn SM, Clarke SJ (2013) Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. J Clin Oncol 31(27):3403–3410

    Article  PubMed  Google Scholar 

  35. Thurston AJ, Wilson DM, Hewitt JA (2011) Current end-of-life care needs and care practices in acute care hospitals. Nurs Res Pract 2011:869302

    PubMed Central  PubMed  Google Scholar 

  36. Tokuda Y, Nakazato N, Tamaki K (2004) Evaluation of end of life care in cancer patients at a teaching hospital in Japan. J Med Ethics 30(3):264–267

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Asai A, Miura Y, Tanabe N, Kurihara M, Fukuhara S (1998) Advance directives and other medical decisions concerning the end of life in cancer patients in Japan. Eur J Cancer 34(10):1582–1586

    Article  CAS  PubMed  Google Scholar 

  38. Bito S, Asai A (2007) Attitudes and behaviors of Japanese physicians concerning withholding and withdrawal of life-sustaining treatment for end-of-life patients: results from an Internet survey. BMC Med Ethics 8:7

    Article  PubMed Central  PubMed  Google Scholar 

  39. Clayton JM, Butow PN, Tattersall MH (2005) When and how to initiate discussion about prognosis and end-of-life issues with terminally ill patients. J Pain Symptom Manage 30(2):132–144

    Article  PubMed  Google Scholar 

  40. Kadooka Y, Asai A, Bito S (2012) Can physicians’ judgments of futility be accepted by patients? A comparative survey of Japanese physicians and laypeople. BMC Med Ethics 13:7

    Article  PubMed Central  PubMed  Google Scholar 

  41. Clayton JM, Butow PN, Tattersall MH, Devine RJ, Simpson JM, Aggarwal G, Clark KJ, Currow DC, Elliott LM, Lacey J, Lee PG, Noel MA (2007) Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol 25(6):715–723

    Article  PubMed  Google Scholar 

  42. Volandes AE, Levin TT, Slovin S, Carvajal RD, O'Reilly EM, Keohan ML, Theodoulou M, Dickler M, Gerecitano JF, Morris M, Epstein AS, Naka-Blackstone A, Walker-Corkery ES, Chang Y, Noy A (2012) Augmenting advance care planning in poor prognosis cancer with a video decision aid: a preintervention-postintervention study. Cancer 118(17):4331–4338

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

The authors report no conflict of interest.

Author information

Author notes

  1. Kosuke Fujimoto

    Present address: Internal Medicine, Allergy and Rheumatic Diseases, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

Authors and Affiliations

  1. Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan

    Kosuke Fujimoto, Seigo Minami, Suguru Yamamoto, Yoshitaka Ogata, Taro Koba, Shinji Futami, Yuh Nishijima, Moto Yaga, Kentaro Masuhiro & Kiyoshi Komuta

Authors
  1. Kosuke Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seigo Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suguru Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshitaka Ogata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taro Koba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinji Futami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuh Nishijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Moto Yaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kentaro Masuhiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kiyoshi Komuta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seigo Minami.

Additional information

Kosuke Fujimoto and Seigo Minami contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fujimoto, K., Minami, S., Yamamoto, S. et al. Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital. Support Care Cancer 22, 1485–1492 (2014). https://doi.org/10.1007/s00520-013-2105-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-2105-z

Keywords

Search

Navigation