Cheng Ya-Hui, Wang Jing-Jy, Wu Kuan-Han, Huang Shan, Kuo Mei- Ling, Su Chao-Hui
Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833, Taiwan.
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
Support Care Cancer. 2016 May;24(5):1999-2006. doi: 10.1007/s00520-015-2971-7. Epub 2015 Oct 30.
The purpose of this study was to investigate the prevalence of do-not-resuscitate (DNR) orders and to identify relevant factors influencing the DNR decision-making process by patients' surrogates in the emergency department (ED).
A prospective, descriptive, and correlational research design was adopted. A total of 200 surrogates of cancer or non-cancer terminal patients, regardless of whether they signed a DNR order, were recruited as subjects after physicians of the emergency department explained the patient's conditions, advised on withholding medical treatment, and provided information on palliative care to all surrogates.
Of the 200 surrogates, 23 % signed a DNR order for the patients. The demographic characteristics of patients and surrogates, the level of understanding of DNR orders, and factors of the DNR decision had no significant influence on the DNR decision. However, greater severity of disease (odds ratio (OR) = 1.38; 95 % confidence interval (CI) = 0.95-1.74), physician's initiative in discussing with the families (OR = 1.42; 95 % CI = 1.21-1.84), and longer length of hospital stay (OR = 1.06; 95 % CI = 1.03-1.08) were contributing factors affecting patient surrogates' DNR decisions.
The findings of this study indicated that surrogates of patients who were more severe in disease condition, whose physicians initiated the discussion of palliative care, and who stayed longer in hospital were important factors affecting the surrogates' DNR decision-making. Therefore, early initiation of DNR discussions is suggested to improve end-of-life care.
本研究旨在调查不进行心肺复苏（DNR）医嘱的普及率，并确定急诊科患者代理人在DNR决策过程中的相关影响因素。
采用前瞻性、描述性和相关性研究设计。在急诊科医生向所有代理人解释患者病情、建议停止医疗治疗并提供姑息治疗信息后，招募了200名癌症或非癌症晚期患者的代理人作为研究对象，无论他们是否签署了DNR医嘱。
在200名代理人中，有23%为患者签署了DNR医嘱。患者和代理人的人口统计学特征、对DNR医嘱的理解程度以及DNR决策因素对DNR决策没有显著影响。然而，疾病严重程度越高（优势比（OR）=1.38；95%置信区间（CI）=0.95-1.74）、医生主动与家属讨论（OR=1.42；95%CI=1.21-1.84）以及住院时间越长（OR=1.06；95%CI=1.03-1.08）是影响患者代理人DNR决策的因素。
本研究结果表明，疾病状况更严重、医生主动发起姑息治疗讨论且住院时间更长的患者的代理人是影响代理人DNR决策的重要因素。因此，建议尽早开始DNR讨论以改善临终关怀。
