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http://dx.doi.org/10.14475/kjhpc.2018.21.2.51

End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience  

Yoon, Sang Eun (Department of Internal Medicine, Ewha Womans University College of Medicine)
Nam, Eun Mi (Department of Internal Medicine, Ewha Womans University College of Medicine)
Lee, Soon Nam (Department of Internal Medicine, Ewha Womans University College of Medicine)
Publication Information
Journal of Hospice and Palliative Care / v.21, no.2, 2018 , pp. 51-57 More about this Journal
Abstract
Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.
Keywords
Resuscitation orders; Decision making; Advance care planning; Terminal care;
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Times Cited By KSCI : 2  (Citation Analysis)
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