Cheng Hon-Wai Benjamin, Shek Pui-Shan Karen, Man Ching-Wah, Chan Oi-Man, Chan Chun-Hung, Lai Kit-Man, Cheng Suk-Ching, Fung Koon-Sim, Lui W K, Lam Carman, Ng Yuen-Kwan, Wong Wan-To, Wong Cherry
1 Medical Palliative Medicine (MPM) unit, Department of Medicine & Geriatrics, Tuen Mun Hospital, NT, Hong Kong.
2 Palliative Home Care Nursing Team, Tuen Mun Hospital, NT, Hong Kong.
Am J Hosp Palliat Care. 2019 Sep;36(9):760-766. doi: 10.1177/1049909119828116. Epub 2019 Feb 11.
Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation performed and less do-not-resuscitate (DNR) orders in place. Nevertheless, death is still often a taboo across Chinese culture, and ethnic disparities could negatively affect DNR directives completion rates.
We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multidisciplinary team approach.
Retrospective chart review of all noncancer patients with life-limiting diseases referred to palliative specialist clinic at a tertiary hospital in Hong Kong over a 4-year period.
Over the study period, a total of 566 noncancer patients were seen, 119 of them completed their own DNR directives. Patients had a mean age of 74.9. Top 3 diagnoses were chronic renal failure (37%), congestive heart failure (16%), and motor neuron disease (11%). Forty-two percent of patients signed their DNR directives at first clinic attendance. Most Chinese patients (76.5%) invited family caregivers at DNR decision-making, especially for female gender (84.4% vs 69.1%; = .047) and older (age >75) age group (86.2% vs 66.7%; = .012). Of the 40 deceased patients, median time from signed directives to death was 5 months. Vast majority (95%) had their DNR directives being honored.
Health-care workers should be sensitive toward the cultural influence during advance care planning. Role of family for ethnic Chinese remains crucial and professionals should respect this family oriented decision-making.
患有危及生命疾病的非癌症患者在生命的最后日子里往往接受更强化的护理，心肺复苏实施得更多，而“不要复苏”（DNR）医嘱的开具较少。然而，在中国文化中，死亡仍然常常是一个禁忌话题，种族差异可能会对DNR指令的完成率产生负面影响。
我们旨在探讨中国非癌症患者在多学科团队模式下的姑息治疗专科门诊是否愿意签署自己的DNR指令。
对一家香港三级医院在4年期间转诊至姑息治疗专科门诊的所有患有危及生命疾病的非癌症患者进行回顾性病历审查。
在研究期间，共诊治了566例非癌症患者，其中119例完成了自己的DNR指令。患者的平均年龄为74.9岁。前三大诊断为慢性肾衰竭（37%）、充血性心力衰竭（16%）和运动神经元病（11%）。42%的患者在首次门诊就诊时签署了DNR指令。大多数中国患者（76.5%）在做出DNR决定时邀请了家庭照顾者，尤其是女性（84.4%对69.1%；P = 0.047）和年龄较大（年龄>75岁）的年龄组（86.2%对66.7%；P = 0.012）。在40例死亡患者中，从签署指令到死亡的中位时间为5个月。绝大多数（95%）患者的DNR指令得到了遵守。
医护人员在进行预先护理计划时应敏感地意识到文化影响。家庭对华裔患者的作用仍然至关重要，专业人员应尊重这种以家庭为导向的决策。
