Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients

Wen, Kuei-Yen; Lin, Ya-Chin; Cheng, Jui-Chen; Chou, Pei-Chun; Wei, Chih-Hsin; Chen, Yunfang; Sun, Jialing

doi:10.1007/s00520-013-1827-2

Cited by 40 publications

(40 citation statements)

References 18 publications

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“…Since its foundation, the organization had launched a website, called “Choice and Dignity,” to provide online advice on making living wills [ 30 ]. However, we should be aware that although there is a lot of evidence regarding ACP and end-of-life care discussions in Western countries, cultural attitudes towards such issues are different in Chinese societies [ 31 ]. Currently, there has been insufficient research to demonstrate the benefits of ACP to eastern Asian patients.…”

Section: Discussionmentioning

confidence: 99%

Attitudes towards Advance Care Planning and Healthcare Autonomy among Community-Dwelling Older Adults in Beijing, China

Zhang

Xia

Zhu

et al. 2015

BioMed Research International

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Objectives. To investigate the preferences of ACP and healthcare autonomy in community-dwelling older Chinese adults. Methods. A community-based cross-sectional study was conducted with older adults living in the residential estate of Chaoyang District, Beijing. Results. 900 residents were enrolled. 80.9% of them wanted to hear the truth regarding their own condition from the physician; 52.4% preferred to make their own healthcare decisions. Only 8.9% of them preferred to endure life-prolonging interventions when faced with irreversible conditions. 78.3% of the respondents had not heard of an ACP; only 39.4% preferred to document in an ACP. Respondents with higher education had significantly higher proportion of having heard of an ACP, as well as preferring to document in an ACP, compared to those with lower education. Those aged <70 years had higher proportion of having heard of an ACP, as well as refusing life-prolonging interventions when faced with irreversible conditions, compared to those aged ≥70 years. Conclusions. Although the majority of community-dwelling older Chinese adults appeared to have healthcare autonomy and refuse life-prolonging interventions in terms of end-of-life care, a low level of “Planning ahead” awareness and preference was apparent. Age and education level may be the influential factors.

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Section: Discussionmentioning

confidence: 99%

Attitudes towards Advance Care Planning and Healthcare Autonomy among Community-Dwelling Older Adults in Beijing, China

Zhang

Xia

Zhu

et al. 2015

BioMed Research International

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“…EOL care planning is therefore seldom discussed early, and DNR orders are more often signed at the last moment. Under such circumstances, it is understandable that all DNR orders were signed by surrogates instead of the patients themselves [14].…”

Section: Discussionmentioning

confidence: 99%

“…In Chinese culture, almost all DNR orders are signed by surrogates because patients are reluctant to discuss death with medical professionals or family members [14]. In our current retrospective study, we performed an 11-year evaluation to investigate the clinical features of patients with advanced-stage lung cancer who died in hospital and to explore the factors contributing to the signing of DNR orders.…”

Section: Introductionmentioning

confidence: 99%

Do-not-resuscitate orders among advanced-stage Chinese lung cancer patients who died in hospital

Wang

Zhao

et al. 2015

Support Care Cancer

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The DNR order-signing rate has been increasing annually among terminal patients with lung cancer in China. DNR orders, all of which were signed by surrogates, were more likely to be accepted by patients with slowly deteriorating disease and longer OS. More effort should be taken to help patients and medical professionals establish a sensible understanding of EOL care, including DNR orders, at earlier points during the disease course.

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“…In a multisite registry study in the United States, Perman et al reported that women are more likely than men to establish DNAR. [28] Other studies, including a study that enrolled hospitalized older adults who required a surrogate decision-maker in the United States [16] and a Taiwanese study that enrolled cancer patients, [29] demonstrated no signi cant gender difference. We speculate that there are some paternalistic perspectives in Japan that autonomy is more emphasized among men than women, while women need to be "protected" from serious medical information.…”

Section: Discussionmentioning

confidence: 99%

Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study

Abe

Kobayashi

Kohno

et al. 2020

Preprint

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BackgroundPatient participation is a key foundation for advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients’ participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and explore their associated factors.MethodsThis is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival (CPAOA); (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients’ involvement in those discussions, and their related factors were investigated.ResultsCPR/DNAR discussion was observed in 336 out of the 359 patients (93.6%). The patient participation rate was 33.3% (n= 112). Male gender (odds ratio (OR) = 2.37 [95% confident interval (CI) 1.32-4.25]), living alone (OR = 2.51 [1.34 - 4.71]) and one year or more from diagnosis (OR = 1.78 [1.03 - 3.10]) were associated with patient’s participation in CPR/DNAR discussion. EOL disclosure was observed in 341 out of the 359 patients (95.0%). Half of the patients (n=171; 50.1%) participated in the discussion. Patients who died of cancer (OR = 2.41[1.45-4.03]) and patients without mental illness (OR=2.41 [1.11-5.25]) were more likely to participate in EOL disclosure.ConclusionsIn this clinical sample, only up to half of the patients participated in CPR/DNAR discussion and EoL disclosure. Further attempts to facilitate patients' participation, based on their preference, are warranted. A few sociodemographic, psychosocial, and medical factors that relate to patients’ participation in the discussion on CPR/DNAR and EOL disclosure were demonstrated.

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Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients

Cited by 40 publications

References 18 publications

Attitudes towards Advance Care Planning and Healthcare Autonomy among Community-Dwelling Older Adults in Beijing, China

Attitudes towards Advance Care Planning and Healthcare Autonomy among Community-Dwelling Older Adults in Beijing, China

Do-not-resuscitate orders among advanced-stage Chinese lung cancer patients who died in hospital

Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study

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