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Cited by 22Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

Determinants of do-not-resuscitate orders in palliative home care

Brink, Peter, Smith, Trevor Frise, Kitson, Maureen·2008·Journal of Palliative Medicine
DOI 10.1089/jpm.2007.0105
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Abstract

OVERVIEW: Do-not-resuscitate (DNR) orders allow home care clients to communicate their own wishes over medical treatment decisions, helping to preserve their dignity and autonomy. To date, little is known about DNR orders in palliative home care. Basic research to identify rates of completion and determinants of DNR orders has yet to be examined in palliative home care. PURPOSE: The purpose of this exploratory study was to determine who in palliative home care has a DNR order as part of their advance directive. METHODS: Information on health was collected using the interRAI instrument for palliative care (interRAI PC). The sample included 470 home care clients from one community care access centre in Ontario. RESULTS: This study indicated that a preference to die at home (odds ratio [OR]: 8.29, confidence interval [CI]: 4.55-15.11); close proximity to death (OR: 0.99, CI: 0.99-1.00); daily incontinence (OR: 2.74, CI: 1.05-7.16); and sleep problems (OR: 1.85, CI: 1.02-3.37) are associated with DNR orders. In addition, clients who are more accepting of their situation are 5.67 times (CI: 1.67-19.27) more likely to have a DNR in place. CONCLUSION: This study represents an important first step to identifying issues related to DNR orders. In addition to proximity to death, incontinence, and sleep problems, acceptance of one's own situation and a preference to die at home are important determinants of DNR completion. The results imply that these discussions might often depend not only on the health of the clients but also on the clients' acceptance of their current situation and where they wish to die.

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  • Cancer increases risk for psychological distress, which is linked with poorer quality of life, greater barriers to quality cancer care, and worse morbidity and mortality.

    “These coping patterns are important because cancer elevates risk for psychological distress (25) which in turn has been linked with poorer QOL (26–28), greater barriers to quality cancer care (29–33) and worse morbidity and mortality (32–36).”

    From Coping in Patients With Incurable Lung and Gastrointestinal Cancers: A Validation Study of the Brief COPE (2017) · cites this paper as [30]

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Authors
Brink, P., Smith, T. F., & Kitson, M.
Affiliations
  • University of Waterloo (CA)
  • Nipissing University (CA)
  • Hamilton Niagra Haldimand Brant Community Care Access Centre, Hamilton, Ontario, Canada.
Venue
Journal of Palliative Medicine
Publisher
SAGE Publications
Published
2008-03
Volume
11
Issue
2
Pages
226-232
ISSN
  • 1096-6218 (ISSN-L)
  • 1557-7740
DOI
10.1089/jpm.2007.0105
OpenAlex
W2090402176
Cited by
22
References
14
Citations by year
2023: 1 · 2022: 1 · 2020: 3 · 2018: 2 · 2017: 1 · 2016: 4 · 2014: 1 · 2013: 1 · 2012: 3
FWCI
1.65
Type
journal article
Language
en
Open access
closed
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Journal of Palliative Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
do-not-resuscitate orders, home-based palliative care, advance directives, end-of-life decisions, patient autonomy, proximity to death, incontinence, sleep disorders
MeSH terms
Activities of Daily Living, Adolescent, Adult, Aged, Aged, 80 and over, Canada, Cognition Disorders, Demography, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Pain, Pain Measurement, Palliative Care, Retrospective Studies, Advance Directives, Resuscitation Orders, Critical Illness, Case Management

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