De Gendt Cindy, Bilsen Johan, Vander Stichele Robert, Lambert Margareta, Den Noortgate NeleVan, Deliens Luc
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
J Am Geriatr Soc. 2005 Dec;53(12):2221-6. doi: 10.1111/j.1532-5415.2005.00503.x.
To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation.
Structured mail questionnaires.
All 94 acute geriatric wards in hospitals in Flanders in 2002 (the year Belgium voted a law on euthanasia).
Head geriatricians.
A questionnaire was mailed about the existence, development, and implementation of the DNR policy (guidelines and order forms), with a request to return copies of existing DNR guidelines and DNR order forms.
The response was 76.6%, with hospital characteristics not significantly different for responders and nonresponders. Development of DNR policy began in 1985, with a step-up in 1997 and 2001. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. Geriatric wards in private hospitals implemented their policy later (P=.01) and more often had order forms (P=.04) than those in public hospitals. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process.
Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions.
描述比利时弗拉芒地区急性老年病房不进行心肺复苏（DNR）政策的历史发展和现状，并与国际情况进行比较。
结构化邮件问卷。
2002年（比利时通过安乐死法律的年份）弗拉芒地区医院的所有94个急性老年病房。
老年科主任。
邮寄一份关于DNR政策（指南和医嘱单）的存在、发展和实施情况的问卷，并要求返还现有DNR指南和DNR医嘱单的副本。
回复率为76.6%，回复者和未回复者的医院特征无显著差异。DNR政策的制定始于1985年，1997年和2001年有所加速。2002年，86.1%的老年病房有DNR政策，主要是机构性DNR指南和针对个体患者的DNR医嘱单。私立医院的老年病房实施该政策较晚（P = 0.01），且比公立医院更常使用医嘱单（P = 0.04）。该政策主要是由医院从机构角度发起和制定的。这些表单未标准化，通常缺乏记录患者参与决策过程情况的空间。
弗拉芒地区老年病房实施机构性DNR指南和个体DNR医嘱单的情况落后于其他国家，2002年仍不完整。DNR政策在内容和范围上各不相同，主要是机构防御态度的一种体现，而非促进患者参与DNR及其他临终决策的工具。
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