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Erschienen in: Supportive Care in Cancer 2/2017

04.10.2016 | Original Article

Do-not-resuscitate consent signed by patients indicates a more favorable quality of end-of-life care for patients with advanced cancer

verfasst von: Yi-Hsin Liang, Chih-Hsin Wei, Wen-Hui Hsu, Yu-Yun Shao, Ya-Chin Lin, Pei-Chun Chou, Ann-Lii Cheng, Kun-Huei Yeh

Erschienen in: Supportive Care in Cancer | Ausgabe 2/2017

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Abstract

Purpose

Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness.

Methods

This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups.

Results

We enrolled 1495 patients. The most prevalent primary cancers were hepato-biliary-pancreatic (26.9 %), lung (16.3 %), and colorectal (14.0 %) cancers. We classified 965 (64.5 %) and 530 (35.5 %) patients into the DNR-S and DNR-P groups, respectively. Significant differences were observed between both groups regarding gender (p = 0.002), age (p < 0.001), and the Eastern Cooperative Oncology Group performance (p < 0.001) and educational (p < 0.001) status levels. The median survival times after DNR consent signature were 5.0 days (95 % confidence interval [CI] 4.4–5.6 days) and 14.0 days (95 % CI 12.1–15.9 days) in the DNR-S and DNR-P groups, respectively (p < 0.001). The median good death evaluation (GDE) scores were 5.4 (95 % CI 4.9–6.0) and 13.7 (95 % CI 12.7–14.6) in the DNR-S and DNR-P groups, respectively (p < 0.001). Univariate and multivariate analyses revealed that DNR-S was an independent factor for significantly low GDE scores (i.e., poor EOL care quality).

Conclusion

The DNR concept is emerging; however, the DNR-P percentage remains low (35.6 %) in patients with advanced cancer. DNR-P significantly improves the EOL care quality.
Literatur
2.
Zurück zum Zitat Murray CJ, Barber RM, Foreman KJ et al (2015) Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet (London, England) 386(10009):2145–2191. doi:10.1016/s0140-6736(15)61340-x CrossRef Murray CJ, Barber RM, Foreman KJ et al (2015) Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet (London, England) 386(10009):2145–2191. doi:10.​1016/​s0140-6736(15)61340-x CrossRef
4.
Zurück zum Zitat Ahmed N, Lobchuk M, Hunter WM, Johnston P, Nugent Z, Sharma A, Ahmed S, Sisler J (2015) How, when and where to discuss do not resuscitate: a prospective study to compare the perceptions and preferences of patients, caregivers, and health care providers in a multidisciplinary lung cancer clinic. Cureus 7(3):e257. doi:10.7759/cureus.257 PubMedPubMedCentral Ahmed N, Lobchuk M, Hunter WM, Johnston P, Nugent Z, Sharma A, Ahmed S, Sisler J (2015) How, when and where to discuss do not resuscitate: a prospective study to compare the perceptions and preferences of patients, caregivers, and health care providers in a multidisciplinary lung cancer clinic. Cureus 7(3):e257. doi:10.​7759/​cureus.​257 PubMedPubMedCentral
5.
Zurück zum Zitat Lefkowits C, Binstock AB, Courtney-Brooks M, Teuteberg WG, Leahy J, Sukumvanich P, Kelley JL (2014) Predictors of palliative care consultation on an inpatient gynecologic oncology service: are we following ASCO recommendations? Gynecol Oncol 133(2):319–325. doi:10.1016/j.ygyno.2014.02.031 CrossRefPubMed Lefkowits C, Binstock AB, Courtney-Brooks M, Teuteberg WG, Leahy J, Sukumvanich P, Kelley JL (2014) Predictors of palliative care consultation on an inpatient gynecologic oncology service: are we following ASCO recommendations? Gynecol Oncol 133(2):319–325. doi:10.​1016/​j.​ygyno.​2014.​02.​031 CrossRefPubMed
7.
Zurück zum Zitat Rhondali W, Perez-Cruz P, Hui D, Chisholm GB, Dalal S, Baile W, Chittenden E, Bruera E (2013) Patient-physician communication about code status preferences: a randomized controlled trial. Cancer 119(11):2067–2073. doi:10.1002/cncr.27981 CrossRefPubMed Rhondali W, Perez-Cruz P, Hui D, Chisholm GB, Dalal S, Baile W, Chittenden E, Bruera E (2013) Patient-physician communication about code status preferences: a randomized controlled trial. Cancer 119(11):2067–2073. doi:10.​1002/​cncr.​27981 CrossRefPubMed
9.
Zurück zum Zitat Kao CY, Wang HM, Tang SC, Huang KG, Jaing TH, Liu CY, Liu KH, Shen WC, Wu JH, Hung YS, Hsu HC, Chen JS, Liau CT, Lin YC, Su PJ, Hsieh CH, Chou WC (2014) Predictive factors for do-not-resuscitate designation among terminally ill cancer patients receiving care from a palliative care consultation service. J Pain Symptom Manag 47(2):271–282. doi:10.1016/j.jpainsymman.2013.03.020 CrossRef Kao CY, Wang HM, Tang SC, Huang KG, Jaing TH, Liu CY, Liu KH, Shen WC, Wu JH, Hung YS, Hsu HC, Chen JS, Liau CT, Lin YC, Su PJ, Hsieh CH, Chou WC (2014) Predictive factors for do-not-resuscitate designation among terminally ill cancer patients receiving care from a palliative care consultation service. J Pain Symptom Manag 47(2):271–282. doi:10.​1016/​j.​jpainsymman.​2013.​03.​020 CrossRef
10.
Zurück zum Zitat Cheng SY, Lin WY, Cheng YH, Huang CH, Chen CY, Hwang SJ, Tsai ST, Chiu TY (2016) Cancer patient autonomy and quality of dying-a prospective nationwide survey in Taiwan. Psychooncology 25(2):179–186. doi:10.1002/pon.3901 CrossRefPubMed Cheng SY, Lin WY, Cheng YH, Huang CH, Chen CY, Hwang SJ, Tsai ST, Chiu TY (2016) Cancer patient autonomy and quality of dying-a prospective nationwide survey in Taiwan. Psychooncology 25(2):179–186. doi:10.​1002/​pon.​3901 CrossRefPubMed
11.
12.
Zurück zum Zitat Wu LF, Chu CM, Chen YG, Ho CL, Pan HH (2015) Relationship between palliative care consultation service and end-of-life outcomes. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. doi:10.1007/s00520-015-2741-6 Wu LF, Chu CM, Chen YG, Ho CL, Pan HH (2015) Relationship between palliative care consultation service and end-of-life outcomes. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. doi:10.​1007/​s00520-015-2741-6
13.
Zurück zum Zitat Cheng SY, Dy S, Fang PH, Chen CY, Chiu TY (2013) Evaluation of inpatient multidisciplinary palliative care unit on terminally ill cancer patients from providers’ perspectives: a propensity score analysis. Jpn J Clin Oncol 43(2):161–169. doi:10.1093/jjco/hys201 CrossRefPubMed Cheng SY, Dy S, Fang PH, Chen CY, Chiu TY (2013) Evaluation of inpatient multidisciplinary palliative care unit on terminally ill cancer patients from providers’ perspectives: a propensity score analysis. Jpn J Clin Oncol 43(2):161–169. doi:10.​1093/​jjco/​hys201 CrossRefPubMed
14.
Zurück zum Zitat Cheng SY, Dy S, Hu WY, Chen CY, Chiu TY (2012) Factors affecting the improvement of quality of dying of terminally ill patients with cancer through palliative care: a ten-year experience. J Palliat Med 15(8):854–862. doi:10.1089/jpm.2012.0033 CrossRefPubMed Cheng SY, Dy S, Hu WY, Chen CY, Chiu TY (2012) Factors affecting the improvement of quality of dying of terminally ill patients with cancer through palliative care: a ten-year experience. J Palliat Med 15(8):854–862. doi:10.​1089/​jpm.​2012.​0033 CrossRefPubMed
15.
Zurück zum Zitat Wen KY, Lin YC, Cheng JF, Chou PC, Wei CH, Chen YF, Sun JL (2013) Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 21(9):2593–2598. doi:10.1007/s00520-013-1827-2 CrossRef Wen KY, Lin YC, Cheng JF, Chou PC, Wei CH, Chen YF, Sun JL (2013) Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 21(9):2593–2598. doi:10.​1007/​s00520-013-1827-2 CrossRef
16.
Zurück zum Zitat Fujimoto K, Minami S, Yamamoto S, Ogata Y, Koba T, Futami S, Nishijima Y, Yaga M, Masuhiro K, Komuta K (2014) Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 22(6):1485–1492. doi:10.1007/s00520-013-2105-z CrossRef Fujimoto K, Minami S, Yamamoto S, Ogata Y, Koba T, Futami S, Nishijima Y, Yaga M, Masuhiro K, Komuta K (2014) Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 22(6):1485–1492. doi:10.​1007/​s00520-013-2105-z CrossRef
17.
Zurück zum Zitat Lee JK, Keam B, An AR, Kim TM, Lee SH, Kim DW, Heo DS (2013) Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 21(1):183–190. doi:10.1007/s00520-012-1509-5 CrossRef Lee JK, Keam B, An AR, Kim TM, Lee SH, Kim DW, Heo DS (2013) Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 21(1):183–190. doi:10.​1007/​s00520-012-1509-5 CrossRef
18.
Zurück zum Zitat Kao CY, Cheng SY, Chiu TY, Chen CY, Hu WY (2013) Does the awareness of terminal illness influence cancer patients’ psycho-spiritual state, and their DNR signing: a survey in Taiwan. Jpn J Clin Oncol 43(9):910–916. doi:10.1093/jjco/hyt095 CrossRefPubMed Kao CY, Cheng SY, Chiu TY, Chen CY, Hu WY (2013) Does the awareness of terminal illness influence cancer patients’ psycho-spiritual state, and their DNR signing: a survey in Taiwan. Jpn J Clin Oncol 43(9):910–916. doi:10.​1093/​jjco/​hyt095 CrossRefPubMed
20.
Zurück zum Zitat Wang Z, Li YS, Zhao N, Yang JJ, Tu HY, Wu YL (2015) Do-not-resuscitate orders among advanced-stage Chinese lung cancer patients who died in hospital. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. doi:10.1007/s00520-015-2966-4 Wang Z, Li YS, Zhao N, Yang JJ, Tu HY, Wu YL (2015) Do-not-resuscitate orders among advanced-stage Chinese lung cancer patients who died in hospital. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. doi:10.​1007/​s00520-015-2966-4
21.
Zurück zum Zitat Shao YY, Hsiue HC, Hsu CH, Chen HM, Lai MS, Cheng AL (2016) Effect of national policy changes on hospice utilization and the invasiveness of end-of-life care in cancer patients. J Clin Oncol 34:suppl;abstr 10008 Shao YY, Hsiue HC, Hsu CH, Chen HM, Lai MS, Cheng AL (2016) Effect of national policy changes on hospice utilization and the invasiveness of end-of-life care in cancer patients. J Clin Oncol 34:suppl;abstr 10008
22.
Zurück zum Zitat Stein RA, Sharpe L, Bell ML, Boyle FM, Dunn SM, Clarke SJ (2013) Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. J Clin Oncol 31(27):3403–3410. doi:10.1200/jco.2011.40.8872 CrossRefPubMed Stein RA, Sharpe L, Bell ML, Boyle FM, Dunn SM, Clarke SJ (2013) Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. J Clin Oncol 31(27):3403–3410. doi:10.​1200/​jco.​2011.​40.​8872 CrossRefPubMed
23.
Zurück zum Zitat Lee YJ, Yang JH, Lee JW, Yoon J, Nah JR, Choi WS, Kim CM (2015) Association between the duration of palliative care service and survival in terminal cancer patients. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 23(4):1057–1062. doi:10.1007/s00520-014-2444-4 CrossRef Lee YJ, Yang JH, Lee JW, Yoon J, Nah JR, Choi WS, Kim CM (2015) Association between the duration of palliative care service and survival in terminal cancer patients. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 23(4):1057–1062. doi:10.​1007/​s00520-014-2444-4 CrossRef
24.
Zurück zum Zitat Parsons HA, de la Cruz MJ, Zhukovsky DS, Hui D, Delgado-Guay MO, Akitoye AE, El Osta B, Palmer L, Palla SL, Bruera E (2010) Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center. Cancer 116(12):3061–3070. doi:10.1002/cncr.25045 CrossRefPubMed Parsons HA, de la Cruz MJ, Zhukovsky DS, Hui D, Delgado-Guay MO, Akitoye AE, El Osta B, Palmer L, Palla SL, Bruera E (2010) Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center. Cancer 116(12):3061–3070. doi:10.​1002/​cncr.​25045 CrossRefPubMed
25.
Zurück zum Zitat Phelps AC, Maciejewski PK, Nilsson M, Balboni TA, Wright AA, Paulk ME, Trice E, Schrag D, Peteet JR, Block SD, Prigerson HG (2009) Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. JAMA 301(11):1140–1147. doi:10.1001/jama.2009.341 CrossRefPubMedPubMedCentral Phelps AC, Maciejewski PK, Nilsson M, Balboni TA, Wright AA, Paulk ME, Trice E, Schrag D, Peteet JR, Block SD, Prigerson HG (2009) Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. JAMA 301(11):1140–1147. doi:10.​1001/​jama.​2009.​341 CrossRefPubMedPubMedCentral
Metadaten
Titel
Do-not-resuscitate consent signed by patients indicates a more favorable quality of end-of-life care for patients with advanced cancer
verfasst von
Yi-Hsin Liang
Chih-Hsin Wei
Wen-Hui Hsu
Yu-Yun Shao
Ya-Chin Lin
Pei-Chun Chou
Ann-Lii Cheng
Kun-Huei Yeh
Publikationsdatum
04.10.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Supportive Care in Cancer / Ausgabe 2/2017
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-016-3434-5

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