Factors Associated With Two Different Protocols of Do-Not-Resuscitate Orders in a Medical ICU*

Chen, Yen-Yuan; Gordon, Nahida H.; Connors, Alfred F.; Garland, Allan; Lai, Hong‐Shiee; Youngner, Stuart J.

doi:10.1097/ccm.0000000000000411

Cited by 9 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Independent patient characteristics associated with a DNR decision were older age and more severe clinical illness. Chen et al 7 conducted a single-center study in Northeast Ohio, also reported that older age, severity of illness at admission to the medical ICU, and race/ethnicity were significantly associated with a DNR order written during ICU stay.…”

Section: Discussionmentioning

confidence: 99%

“…The generalizability of the results of this single-center study is as good as several prior studies as indicated by the percentage of patients who had a DNR order written, age, and severity of illness upon SICU admissions. 7,11,31 …”

Section: Discussionmentioning

confidence: 99%

“…6–8 The factors shown to be related to DNR decisions were older age, 7,9–11 white race, 7,12 and more severe illnesses at admission. 7,13 In addition, several studies have been focused on the medical care DNR patients received after the orders were written. They have reported that DNR decisions are linked to fewer life-supporting treatments (LSTs), a lower likelihood of physiologic monitoring, and a lower likelihood of being admitted to intensive care units (ICUs).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan

Lin

Chen

Chou³

et al. 2016

Medicine

Self Cite

View full text Add to dashboard Cite

Prior studies have demonstrated important implications related to religiosity and a do-not-resuscitate (DNR) decision. However, the association between patients’ religious background and DNR decisions is vague. In particular, the association between the religious background of Buddhism/Daoism and DNR decisions has never been examined. The objective of this study was to examine the association between patients’ religious background and their DNR decisions, with a particular focus on Buddhism/Daoism.The medical records of the patients who were admitted to the 3 surgical intensive care units (SICU) in a university-affiliated medical center located at Northern Taiwan from June 1, 2011 to December 31, 2013 were retrospectively collected. We compared the clinical/demographic variables of DNR patients with those of non-DNR patients using the Student t test or χ2 test depending on the scale of the variables. We used multivariate logistic regression analysis to examine the association between the religious backgrounds and DNR decisions.A sample of 1909 patients was collected: 122 patients had a DNR order; and 1787 patients did not have a DNR order. Old age (P = 0.02), unemployment (P = .02), admission diagnosis of “nonoperative, cardiac failure/insufficiency” (P = 0.03), and severe acute illness at SICU admission (P < 0.01) were significantly associated with signing of DNR orders. Patients’ religious background of Buddhism/Daoism (P = 0.04), married marital status (P = 0.02), and admission diagnosis of “postoperative, major surgery” (P = 0.02) were less likely to have a DNR order written during their SICU stay. Furthermore, patients with poor social support, as indicated by marital and working status, were more likely to consent to a DNR order during SICU stay.This study showed that the religious background of Buddhism/Daoism was significantly associated with a lower likelihood of consenting to a DNR, and poor social support was significantly associated with a higher likelihood of having a DNR order written during SICU stay.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan

Lin

Chen

Chou³

et al. 2016

Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some studies were focused on examining the factors associated with DNR decisions. The prevalence of DNR varied from setting to setting and institution to institution, from approximately 4% to 41% 4 5 6 7 8 . Some studies examined health care professionals’ attitudes toward DNR, and showed that physicians and nurses were reluctant to perform a variety of physiologic monitoring modalities, medical interventions, and nursing care for DNR patients 9 10 11 12 .…”

mentioning

confidence: 99%

“…For example, Hemphill et al ’s and Shepardson et al ’s studies both showed that, for stroke patients, there was an increased risk of death for DNR patients compared with patients without DNR 15 16 ; Kazaure et al reported that, for surgical patients, a DNR order remained an independent risk factor associated with death 17 . In addition, not only the studies conducted in general wards, but also those conducted in intensive care units showed that a DNR decision was significantly associated with an increased risk of death 8 18 .…”

mentioning

confidence: 99%

Further deliberating the relationship between do-not-resuscitate and the increased risk of death

Chen

Chu

et al. 2016

Sci Rep

Self Cite

View full text Add to dashboard Cite

Few studies have examined the outcome of do-not-resuscitate (DNR) patients in surgical intensive care units (SICUs). This study deliberated the association between a DNR decision and the increased risk of death methodologically and ethically. This study was conducted in three SICUs. We collected patients’ demographic characteristics, clinical characteristics, and the status of death/survival at SICU and hospital discharge. We used Kaplan–Meier survival curves to compare the time from SICU admission to the end of SICU stay for the DNR and non-DNR patients. Differences in the Kaplan-Meier curves were tested using log-rank tests. We also conducted a Cox proportional hazards model to account for the effect of a DNR decision on mortality. We found that having a DNR order was associated with an increased risk of death during the SICU stay (aRR = 2.39, p < 0.01) after adjusting for severity of illness upon SICU admission and other confounding variables. To make the conclusion that a DNR order is causally related to an increased risk of death, or that a DNR order increases the risk of death is absolutely questionable. By clarifying this key point, we expect that the discussion of DNR between healthcare professionals and patients/surrogate decision-makers will not be hampered or delayed.

show abstract

A Unique Look at Ohio’s Do-Not-Resuscitate Law

Anderson-Shaw¹

2014

Critical Care Medicine

View full text Add to dashboard Cite

I n this issue of Critical Care Medicine, the article by Chen et al (1) highlights the use of two different protocols of donot-resuscitate (DNR) orders. These specific DNR protocols are legislated by the State of Ohio and are standard of care for patients who have a DNR order in that state (2). The first proto col is do-not-resuscitate comfort care-arrest (DNRCC-Arrest) and the second is do-not-resuscitate comfort care (DNRCC). The study objective in this article was to compare clinical, demo graphic, and outcome data between patients with DNRCC-Arrest and DNRCC orders in an ICU setting. The results of this comparison using factors associated with DNR (older age, race, and severe clinical illness on admit to ICU) were similar to previous research published on the same topic (3-5). Explora tion of these two defined protocols by critical care practitioners throughout the United States would be very interesting and per haps would provide clarity to DNR orders in general.A major strength of this study is the authors claim that no previous studies have been published that compares the two DNR protocols used in Ohio. This is im portant as the Ohio's Do-Not-Resuscitate law was enacted in 1998 (6) and affects many healthcare institutions, providers, and patients in the State of Ohio. The authors define the variables of DNRCC and DNRCC-Arrest very well as many critical care providers may not be familiar to these terms/protocols. The study protocol is also im portant for this study in that all patients were cared for by a single team of physicians and were enrolled in the study by these team members, which helped control for biases related to consistency that can occur in clinical studies when provider team members fre quently rotate in/out or cross cover patient care and may be expected to assist with study subject recruitment. Consis tent care providers may also enhance trust between patient and providers related to end-of-life discussions. End-of-life discussions can be uncomfortable for providers, patients, and family members, especially when the patient is in the 'S e e also p. 2188.

show abstract

Factors Associated With Two Different Protocols of Do-Not-Resuscitate Orders in a Medical ICU*

Abstract: Our study showed that some clinical/demographic factors predicted do-not-resuscitate comfort care orders. This study also suggested that Ohio's Do-Not-Resuscitate Law, clearly indicating two different protocols of do-not-resuscitate orders, facilitated early do-not-resuscitate decision.

Cited by 9 publications

References 25 publications

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan

Further deliberating the relationship between do-not-resuscitate and the increased risk of death

A Unique Look at Ohio’s Do-Not-Resuscitate Law

Contact Info

Product

Resources

About