Department of Nursing,Koo Foundation Sun Yat-Sen Cancer Center,Taipei,Taiwan.
School of Nursing, College of Medicine,National Taiwan University,Nursing Department,National Taiwan University Hospital,Taipei,Taiwan.
Palliat Support Care. 2019 Feb;17(1):95-106. doi: 10.1017/S1478951518000196. Epub 2018 Jun 18.
The aims of this systematic review were to examine the effects of the overall and the different types of the interventions on the do-not-resuscitate (DNR) designation and the time between DNR and death among cancer patients.
Data were searched from the databases of PubMed, CINAHL, EMbase, Medline, and Cochrane Library through 2 November 2017. Studies were eligible for inclusion if they were (1) randomized control trails, quasi-experimental study, and retrospective observational studies and (2) used outcome indicators of DNR designation rates. The Effective Public Health Practice Project tool was used to assess the overall quality of the included studies.
The 14 studies with a total of 7,180 participants were included in this review. There were 78.6% (11 of 14) studies that indicated that the interventions could improve the DNR designation rates. Three types of DNR interventions were identified in this review: palliative care unit service, palliative consultation services, and patient-physician communication program. The significant increases of the time between DNR designation and death only occurred in a patient-physician communication program.
The palliative care unit service provided a continuing care model to reduce unnecessary utilization of healthcare service. The palliative consultation service is a new care model to meet the needs of cancer patients in non-palliative care unit. The share decision-making communication program and physician's compassion attitudes facilitate to make DNR decision early. The individualized DNR program needs to be developed according to the needs of cancer patients.
本系统评价旨在考察整体及不同干预类型对癌症患者的不复苏（DNR）指定率及 DNR 与死亡之间时间的影响。
通过 2017 年 11 月 2 日检索 PubMed、CINAHL、EMbase、Medline 和 Cochrane Library 数据库，纳入符合以下标准的研究：（1）随机对照试验、准实验研究和回顾性观察研究；（2）使用 DNR 指定率的结局指标。采用有效公共卫生实践项目工具评估纳入研究的总体质量。
本研究共纳入 14 项研究，总计 7180 名参与者。其中 78.6%（11/14）的研究表明干预措施可提高 DNR 指定率。本研究共确定了 3 种 DNR 干预类型：姑息治疗病房服务、姑息治疗咨询服务和医患沟通方案。仅在医患沟通方案中，DNR 指定与死亡之间的时间显著延长。
姑息治疗病房服务提供了一种持续护理模式，以减少不必要的医疗服务利用。姑息治疗咨询服务是一种满足非姑息治疗病房癌症患者需求的新护理模式。共同决策沟通方案和医生的同情心态度有助于尽早做出 DNR 决策。需要根据癌症患者的需求制定个体化的 DNR 方案。
