School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan Province, China.
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
Support Care Cancer. 2021 Apr;29(4):1893-1902. doi: 10.1007/s00520-020-05672-x. Epub 2020 Aug 15.
The objectives are to explore the prevalence of DNR orders, the factors influencing them, and the association between DNR signing and health care utilization among advanced cancer patients.
This was a retrospective cohort study. Data from cancer decedents in three hospitals in China from January 2016 to December 2017 during their last hospitalization before death were obtained from the electronic medical records system.
In total, 427 cancer patients were included; 59.0% had a DNR order. Patients who had solid tumors, lived in urban areas, had more than one comorbidity, and had more than five symptoms were more likely to have DNR orders. The cut-off of the timing of obtaining a DNR order was 3 days, as determined by the median number of days from the signing of a DNR order to patient death. Patients with early DNR orders (more than 3 days before death) were less likely to be transferred to the intensive care unit and undergo cardiopulmonary resuscitation, tracheal intubation, and ventilation, while they were more likely to be given morphine and psychological support compared with those with late (within 3 days before death) and no orders.
Advanced cancer patients with solid tumors living in urban areas with more symptoms and comorbidities are relatively more likely to have DNR orders. Early DNR orders are associated with less aggressive procedures and more comfort measures. However, these orders are always signed late. Future studies are needed to better understand the timing of DNR orders.
本研究旨在探讨晚期癌症患者的 DNR 医嘱的流行情况、影响因素，以及 DNR 签署与医疗保健利用之间的关系。
本研究采用回顾性队列研究设计。研究数据来自中国 3 家医院 2016 年 1 月至 2017 年 12 月期间在死亡前最后一次住院的癌症患者的电子病历系统。
共纳入 427 名癌症患者，其中 59.0%的患者有 DNR 医嘱。患有实体瘤、居住在城市、有多种合并症、有超过 5 种症状的患者更有可能有 DNR 医嘱。通过确定从 DNR 医嘱签署到患者死亡的中位数天数，获得 DNR 医嘱时间的截止点为 3 天。与晚期（死亡前 3 天内）和无医嘱相比，早期（死亡前超过 3 天）获得 DNR 医嘱的患者更不可能被转至重症监护病房并接受心肺复苏、气管插管和通气，而更有可能接受吗啡和心理支持。
患有实体瘤、居住在城市、症状和合并症较多的晚期癌症患者，更有可能有 DNR 医嘱。早期 DNR 医嘱与侵袭性较小的治疗措施和更多的舒适措施相关，但这些医嘱通常签署得较晚。未来需要进一步研究以更好地了解 DNR 医嘱的时机。
