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- Title
Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department.
- Authors
Cheng, Ya-Hui; Wang, Jing-Jy; Wu, Kuan-Han; Huang, Shan; Kuo, Mei-; Su, Chao-Hui; Kuo, Mei- Ling
- Abstract
<bold>Purpose: </bold>The purpose of this study was to investigate the prevalence of do-not-resuscitate (DNR) orders and to identify relevant factors influencing the DNR decision-making process by patients' surrogates in the emergency department (ED).<bold>Methods: </bold>A prospective, descriptive, and correlational research design was adopted. A total of 200 surrogates of cancer or non-cancer terminal patients, regardless of whether they signed a DNR order, were recruited as subjects after physicians of the emergency department explained the patient's conditions, advised on withholding medical treatment, and provided information on palliative care to all surrogates.<bold>Results: </bold>Of the 200 surrogates, 23 % signed a DNR order for the patients. The demographic characteristics of patients and surrogates, the level of understanding of DNR orders, and factors of the DNR decision had no significant influence on the DNR decision. However, greater severity of disease (odds ratio (OR) = 1.38; 95 % confidence interval (CI) = 0.95-1.74), physician's initiative in discussing with the families (OR = 1.42; 95 % CI = 1.21-1.84), and longer length of hospital stay (OR = 1.06; 95 % CI = 1.03-1.08) were contributing factors affecting patient surrogates' DNR decisions.<bold>Conclusions: </bold>The findings of this study indicated that surrogates of patients who were more severe in disease condition, whose physicians initiated the discussion of palliative care, and who stayed longer in hospital were important factors affecting the surrogates' DNR decision-making. Therefore, early initiation of DNR discussions is suggested to improve end-of-life care.
- Subjects
TAIWAN; EMERGENCY medical services; DO-not-resuscitate orders; TERMINAL care; LENGTH of stay in hospitals; MEDICAL decision making; PALLIATIVE treatment; TUMOR treatment; TUMORS &; psychology; COMPARATIVE studies; DECISION making; HOSPITAL emergency services; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MEDICAL personnel; QUALITY of life; RESEARCH; EVALUATION research; PASSIVE euthanasia; PATIENTS' families; ETHICS; PSYCHOLOGY
- Publication
Supportive Care in Cancer, 2016, Vol 24, Issue 5, p1999
- ISSN
0941-4355
- Publication type
journal article
- DOI
10.1007/s00520-015-2971-7