Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients
- 1.5k Downloads
Discussing end-of-life care with patients is often considered taboo, and signing a do-not-resuscitate (DNR) order is difficult for most patients, especially in Chinese culture. This study investigated distributions and details related to the signing of DNR orders, as well as the completeness of various DNR order forms.
Retrospective chart reviews were performed. We screened all charts from a teaching hospital in Taiwan for patients who died of cancer during the period from January 2010 to December 2011. A total of 829 patient records were included in the analysis. The details of the DNR order forms were recorded.
The DNR order signing rate was 99.8 %. The percentage of DNR orders signed by patients themselves (DNR-P) was 22.6 %, while the percentage of orders signed by surrogates (DNR-S) was 77.2 %. The percentage of signed DNR forms that were completely filled out was 78.4 %. The percentage of DNR-S forms that were completed was 81.7 %, while the percentage of DNR-P forms that were completely filled out was only 67.6 %.
Almost all the cancer patients had a signed DNR order, but for the majority of them, the order was signed by a surrogate. Negative attitudes of discussing death from medical professionals and/or the family members of patients may account for the higher number of signed DNR-S orders than DNR-P orders. Moreover, early obtainment of signed DNR orders should be sought, as getting the orders earlier could promote the quality of end-of-life care, especially in non-oncology wards.
KeywordsChinese culture Palliative care Do-not-resuscitate (DNR) End-of-life care discussion Cancer
The study was supported by the National Taiwan University Hospital, Hsinchu Branch (no. 100-HCH-28).
Conflict of interest
The authors declare no conflict of interest. We have full control of all primary data and agree to allow the journal to review the data if requested.
- 3.Tsai YS, Lin YL, Huang SJ (2007) End-of-life care in critical illness. Taiwan J Hosp Palliat Care 12(3):312–321Google Scholar
- 4.Wu CM, Hsueh EJ, Chung CY, Liu HL, Wen YJ, Jung YY (2009) The status of signing do-not-resuscitate orders in terminal cancer patients and analysis of the related factors. Taiwan J Hosp Palliat Care 12(3):243–253Google Scholar
- 15.Hospice and Palliative Regulation·(2011) Laws and regulations databases of the Republic of China. http://law.moj.gov.tw/LawClass/LawContent.aspx?PCODE=L0020066
- 16.Department of Health, Executive Yuan of Taiwan (2010) Safeguard body autonomy and ensure life dignity. http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&now_fod_list_no=10980&level_no=2&doc_no=76096
- 23.Mori M, Ellison D, Ashikaga T, McVeigh U, Ramsay A, Ades S (2013) In-advance end-of-life discussions and the quality of inpatient end-of-life care: a pilot study in bereaved primary caregivers of advanced cancer patients. Support Care Cancer 21(2):629–636. doi: 10.1007/s00520-012-1581-x CrossRefGoogle Scholar
Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.