What is the true definition of a &amp;quot;Do-Not-Resuscitate&amp;quot; order? A Japanese perspective

Hiraoka, Eiji; Homma, Yosuke; Norisue, Yasuhiro; Naito, Takaki; Kataoka, Yuko; Hamada, Osamu; Den, Yo; Takahashi, Osamu; Fujitani, Shigeki

doi:10.2147/ijgm.s105302

Cited by 14 publications

(12 citation statements)

References 27 publications

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“…Although Japan has no official guidelines for DNR orders, [22] it was the first Asian country to address “death with dignity” as “an act of withdrawing or withholding all life-prolonging measures on the basis of patients’ wishes when they are in their terminal stage of life.” [23,24] In China, Taiwan has a similar definition. [3] On June 7, 2000, the Hospice Palliative Care Act (HPCA) was signed into law in Taiwan, allowing a natural death for terminal patients, including DNR orders.…”

Section: Introductionmentioning

confidence: 99%

The do-not-resuscitate order for terminal cancer patients in mainland China

Huang¹,

Chen

Wang

et al. 2018

Medicine

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With the development of palliative care, a signed do-not-resuscitate (DNR) order has become increasingly popular worldwide. However, there is no legal guarantee of a signed DNR order for patients with cancer in mainland China. This study aimed to estimate the status of DNR order signing before patient death in the cancer center of a large tertiary affiliated teaching hospital in western China. Patient demographics and disease-related characteristics were also analyzed.This was a retrospective chart analysis. We screened all charts from a large-scale tertiary teaching hospital in China for patients who died of cancer from January 2010 to February 2015. Analysis included a total of 365 records. The details of DNR order forms, patient demographics, and disease-related characteristics were recorded.The DNR order signing rate was 80%. Only 2 patients signed the DNR order themselves, while the majority of DNR orders were signed by patients' surrogates. The median time for signing the DNR order was 1 day before the patients' death. Most DNR decisions were made within the last 3 days before death. The time at which DNR orders were signed was related to disease severity and the rate of disease progression.Our findings indicate that signing a DNR order for patients with terminal cancer has become common in mainland China in recent years. Decisions about a DNR order are usually made by patients' surrogates when patients are severely ill. Palliative care in mainland China still needs to be improved.

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Section: Introductionmentioning

confidence: 99%

The do-not-resuscitate order for terminal cancer patients in mainland China

Huang¹,

Chen

Wang

et al. 2018

Medicine

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“…Second, we did not have data on quality measures before starting the DNR lectures; therefore, we cannot make a definitive conclusion that regular lectures on DNR can prevent the misuse of DNR order for HF treatment. However, in Japan, the DNR order reportedly affects non-CPR procedure, 10 and we believe the lectures played an important role in its proper implementation for HF treatment. Third, although the adequate frequency of lectures on DNR order remains to be investigated, the frequency we use in our hospital, every 3 months, is feasible for other hospitals.…”

Section: Discussionmentioning

confidence: 90%

“…12 However, the interpretation of a DNR order reportedly differs and can affect the decision making for procedures other than CPR in Japan. 10 Still, the DNR order carries the risk of withholding or withdrawing non-CPR procedures in Japan. Our hospital program provides internal medicine residents and physicians with lectures of DNR orders every 3 months, in which they learn the definition of DNR order and that in the presence of DNR orders, the indication for other procedures should be discussed with patients and their families in cases of advanced stage of illness.…”

Section: Discussionmentioning

confidence: 99%

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Effect of a do-not-resuscitate order on the quality of care in acute heart failure patients: a single-center cohort study

Kojima¹,

Hiraoka²,

Arai³

et al. 2018

IJGM

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BackgroundA do-not-resuscitate (DNR) order is reportedly associated with a decrease in performance measures, but it should not be applied to noncardiopulmonary resuscitation procedures. Good performance measures are associated with improvement in heart failure outcomes.AimTo analyze the influence of DNR order on performance measures of heart failure at our hospital, where lectures on DNR order are held every 3 months.DesignRetrospective cohort study.MethodsThe medical report of patients with acute heart failure who were admitted between April 2013 and March 2015 were retrospectively analyzed. We collected demographic data, information on the presence or absence of DNR order within 24 hours of admission, and inhospital mortality. Performance measures of heart failure, including assessment of cardiac function and discharge prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and beta-blocker for left ventricular systolic dysfunction and anticoagulant for atrial fibrillation, were collected and compared between groups with and without DNR orders.ResultsIn 394 total patients and 183 patients with left ventricular systolic dysfunction, 114 (30%) and 44 (24%) patients, respectively, had a DNR order. Patients with a DNR order had higher inhospital mortality. There were no significant differences between the two groups in terms of the four quality measures (left ventricular function assessment, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, and anticoagulant).ConclusionDNR orders did not affect performance measures, but they were associated with higher inhospital mortality among acute heart failure patients.

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“…[ 33 ] Japanese physicians have also found that the DNR order can influence performing the CPR procedure. [ 34 ]…”

Section: Discussionmentioning

confidence: 99%

Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

Assarroudi

Nabavi

Ebadi

et al. 2017

Indian J Palliat Care

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Background:One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order.Methods:CPR team members were interviewed, and data were analyzed using a conventional content analysis method.Results:Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.”Conclusion:There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

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What is the true definition of a "Do-Not-Resuscitate" order? A Japanese perspective

Cited by 14 publications

References 27 publications

The do-not-resuscitate order for terminal cancer patients in mainland China

The do-not-resuscitate order for terminal cancer patients in mainland China

Effect of a do-not-resuscitate order on the quality of care in acute heart failure patients: a single-center cohort study

Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

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