The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre

Jacqueline Ming Liu, Wei Chun Lin, Yuh Min Chen, Hsiao Wei Wu, Nai Shun Yao, Li Tzong Chen, Jacqueline Whang-Peng

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective - To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. Design - Retrospective descriptive study. Setting - A cancer clinical trials unit in a large teaching hospital. Patients - From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. Main measurement - Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. Results - DNR orders were written of 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patints were taken home to die, a more likely occurrence if the patient was over 75 yerars (odds rtatio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. Conclusions - DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom.

Original languageEnglish
Pages (from-to)309-314
Number of pages6
JournalJournal of Medical Ethics
Volume25
Issue number4
DOIs
Publication statusPublished - Jan 1 1999
Externally publishedYes

Fingerprint

Resuscitation Orders
cancer
Clinical Trials
Neoplasms
dying
Odds Ratio
pain
Cancer
death
decision making
event
Teaching
language
Cardiopulmonary Resuscitation
Teaching Hospitals
Analgesia
Opioid Analgesics
Decision Making
Language

Keywords

  • AAD: discharge against advice
  • CPR: cardiopulmonary resuscitation
  • DBR: do not resuscitate
  • End-of-life directives

ASJC Scopus subject areas

  • Health(social science)
  • Issues, ethics and legal aspects
  • Arts and Humanities (miscellaneous)
  • Health Policy

Cite this

The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre. / Liu, Jacqueline Ming; Lin, Wei Chun; Chen, Yuh Min; Wu, Hsiao Wei; Yao, Nai Shun; Chen, Li Tzong; Whang-Peng, Jacqueline.

In: Journal of Medical Ethics, Vol. 25, No. 4, 01.01.1999, p. 309-314.

Research output: Contribution to journalArticle

Liu, Jacqueline Ming ; Lin, Wei Chun ; Chen, Yuh Min ; Wu, Hsiao Wei ; Yao, Nai Shun ; Chen, Li Tzong ; Whang-Peng, Jacqueline. / The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre. In: Journal of Medical Ethics. 1999 ; Vol. 25, No. 4. pp. 309-314.
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abstract = "Objective - To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. Design - Retrospective descriptive study. Setting - A cancer clinical trials unit in a large teaching hospital. Patients - From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. Main measurement - Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. Results - DNR orders were written of 64.4{\%} of patients. Patients in pain (odds ratio 0.45, 95{\%} CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95{\%} CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patints were taken home to die, a more likely occurrence if the patient was over 75 yerars (odds rtatio 0.12, 95{\%} CI 0.04-0.34), had children (odds ratio 0.14, 95{\%} CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95{\%} CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95{\%} CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. Conclusions - DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20{\%} of dying patients are taken home to die, in accordance with local custom.",
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AU - Liu, Jacqueline Ming

AU - Lin, Wei Chun

AU - Chen, Yuh Min

AU - Wu, Hsiao Wei

AU - Yao, Nai Shun

AU - Chen, Li Tzong

AU - Whang-Peng, Jacqueline

PY - 1999/1/1

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N2 - Objective - To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. Design - Retrospective descriptive study. Setting - A cancer clinical trials unit in a large teaching hospital. Patients - From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. Main measurement - Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. Results - DNR orders were written of 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patints were taken home to die, a more likely occurrence if the patient was over 75 yerars (odds rtatio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. Conclusions - DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom.

AB - Objective - To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. Design - Retrospective descriptive study. Setting - A cancer clinical trials unit in a large teaching hospital. Patients - From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. Main measurement - Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. Results - DNR orders were written of 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patints were taken home to die, a more likely occurrence if the patient was over 75 yerars (odds rtatio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. Conclusions - DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom.

KW - AAD: discharge against advice

KW - CPR: cardiopulmonary resuscitation

KW - DBR: do not resuscitate

KW - End-of-life directives

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