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Cited by 19Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

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Factors influencing terminal cancer patients’ autonomous DNR decision: a longitudinal statutory document and clinical database study

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Chen, Ru-Yih, Li, Ying-Chun, Hsueh, Kuang-Chieh, Wang, Fu-Wei, Chen, Hong-Jhe, Huang, Tzu-Ya·2022·BMC Palliative Care
DOI 10.1186/s12904-022-01037-9PMC PMC9419392
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Abstract

Objective: Much of our knowledge of patient autonomy of DNR (do-not-resuscitate) is derived from the cross-sectional questionnaire surveys. Using signatures on statutory documents and medical records, we analyzed longitudinal data to understand the fact of terminal cancer patients’ autonomous DNR decision-making in Taiwan. Methods: Using the medical information system database of one public medical center in Taiwan, we identified hospitalized cancer patients who died between Jan. 2017 and Dec. 2018, collected their demographic and clinical course data and records of their statutory DNR document types, letter of intent (DNR-LOI) signed by the patient personally and the consent form signed by their close relatives. Results: We identified 1,338 signed DNR documents, 754 (56.35%) being DNR-LOI. Many patients had the first DNR order within their last week of life (40.81%). Signing the DNR-LOI was positively associated with being under the care of a family medicine physician prior to death at last hospitalization and having hospice palliative care and negatively associated with patient age ≥ 65 years, no formal education, having ≥ 3 children, having the first DNR order to death ≤ 29 days, and the last admission in an intensive care unit. Conclusions: A substantial proportion of terminal cancer patients did not sign DNR documents by themselves. It indicates they may not know their actual terminal conditions and lose the last chance to grasp time to express their life values and wishes. Medical staff involving cancer patient care may need further education on the legal and ethical issues revolving around patient autonomy and training on communicating end-of-life options with the patients. We suggest proactively discussing DNR decision issues with terminal cancer patients no later than when their estimated survival is close to 1 month.

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Metadata

Authors
Chen, R.-Y., Li, Y.-C., Hsueh, K.-C., Wang, F.-W., Chen, H.-J., & Huang, T.-Y.
Affiliations
  • National Sun Yat-sen University (TW)
  • Kaohsiung Veterans General Hospital (TW)
Corresponding author
Li, Ying-Chun
ORCID
Venue
BMC Palliative Care
Publisher
Springer Science and Business Media LLC
Published
2022-08-27
Volume
21
Issue
1
Pages
149-149
ISSN
1472-684X (ISSN-L)
DOI
10.1186/s12904-022-01037-9
PMC
PMC9419392
OpenAlex
W4293468290
Cited by
19
References
2
Citations by year
2026: 6 · 2025: 3 · 2024: 4 · 2023: 6
FWCI
2.87
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Palliative Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Kaohsiung Veterans General Hospital (VGHKS107-028.)
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, terminal cancer patients, patient autonomy, advance directives, letter of intent, end-of-life decisions, hospice and palliative care, intensive care unit admission, end-of-life communication, Taiwan
MeSH terms
Aged, Child, Cross-Sectional Studies, Humans, Neoplasms, Palliative Care, Resuscitation Orders, Hospice Care

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