Symptomatic Features and Factors Associated With Do-Not-Resuscitate Consent in Advanced Cancer Patients Admitted to Palliative Care Ward

Abstract

This study aimed to conduct a retrospective cross-sectional study to investigate the prevalence of symptoms and symptom clusters on sociodemographic and disease characteristics, as well as factors associated with Do-Not-Resuscitate (DNR) consent. Advanced cancer patients were enrolled between 2018 and 2020 with available data. Demographic and clinical data were obtained for analysis from Hospital Information System (HIS) in China. Symptom clusters were extracted by hierarchical cluster analysis. Chi-square test and multiple logistic regression were conducted to investigate the prevalence characteristics of symptoms and influencing factors of DNR consent, respectively. 798 advanced cancer patients were enrolled. The most prevalent symptoms were pain (93%), anorexia (36.5%), and sleep disorders (34.2%). High heart rate was associated with poor performance status and more symptoms. Three clusters were extracted: fatigue-related, respiratory-circulatory system, and digestive system symptom clusters. The incidence of symptoms was statistically significant in age, gender, education level, residence, BMI, performance status, distress score, ADL, and primary pain level. The DNR signature rate was 15.5%. Female, distant metastasis, in-ward rescue, and appearance of dyspnea were independent influencing factors of DNR signature. Chinese hospitalized cancer patients had more symptoms burden that were influenced by various demographic characteristics, especially pain and fatigue-related symptoms. Concerning the trajectory of vital signs is important among advanced cancer patients. The DNR signature rate was lower and our finding indicating an urgency to accurately assess the prognosis and give more palliative care education to enhance DNR rates and early signing in Chinese context.

Vital Signs in Palliative Care: A Scoping Review

“…The search strategy identified 8697 references, although only 131 full text articles were retrieved ( Figure 1 ). Twenty-six studies were identified during the initial database searches [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]; three further studies were identified during the re-searches in June 2023 [ 40 , 41 , 42 ]. The studies identified included 26 prognostication studies [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 37 , 38 , …”

“…The three non-prognostic studies also involved variable/limited numbers of patients (median: 102; range: 30–798) [ 35 , 36 , 42 ]. Pearse et al only assessed blood pressure [ 35 ], and this was measured on admission to the hospice.…”

“…In contrast, Pavic et al assessed heart rate (and heart rate variability), skin temperature, and oxygen saturation, and these were continuously measured during the study period (up to 12 weeks) [ 36 , 44 ]. Fan et al assessed heart rate and blood pressure, and this was only assessed on admission to the hospital [ 42 ].…”

“…Fan et al found that high heart rate (>100/min) was associated with more symptoms ( p = 0.047) and a worse performance status ( p = 0.001) [ 42 ]. They suggested that “sustained attention on the change trajectory of vital signs like heart rates and blood pressure of advanced cancer patients is important, which may help make the prediction of patient’s clinical course”.…”

“…The search strategy identified 8697 references, although only 131 full text articles were retrieved (Figure 1). Twenty-six studies were identified during the initial database searches ; three further studies were identified during the re-searches in June 2023 [40][41][42]. The studies identified included 26 prognostication studies [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][37][38][39][40][41]43] and three non-prognostication studies [35,36,42].…”