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.
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Abbreviations
- EOL:
-
End-of-life
- DNR:
-
Do-not-resuscitate
- DNR-S:
-
DNR consents signed by surrogates
- DNR-P:
-
DNR consents signed by patients
- NTUH-H:
-
National Taiwan University Hospital, Hsin-Chu Branch
- GDE:
-
Good death evaluation
- SASD:
-
Survival after signature of DNR consent
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Liang, YH., Wei, CH., Hsu, WH. et al. Do-not-resuscitate consent signed by patients indicates a more favorable quality of end-of-life care for patients with advanced cancer. Support Care Cancer 25, 533–539 (2017). https://doi.org/10.1007/s00520-016-3434-5
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DOI: https://doi.org/10.1007/s00520-016-3434-5