Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, UK.
Int J Environ Res Public Health. 2021 Aug 2;18(15):8194. doi: 10.3390/ijerph18158194.
: Patients with advanced kidney disease have a symptomatic and psychological burden which warrant renal supportive care or palliative care. However, the impact of do-not-resuscitate consent type (signed by patients or surrogates) on end-of-life treatments in these patients remains unclear. : We aim to identify influential factors correlated with different do-not-resuscitate consent types in patients with advanced kidney disease and the impact of do-not-resuscitate consent types on various life-prolonging treatments. This was a retrospective observational study. We included patients aged 20 years and over, diagnosed with advanced kidney disease and receiving palliative and hospice care consultation services between January 2014 and December 2018 in a tertiary teaching hospital in Taiwan. We reviewed medical records and used logistic regression to identify factors associated with do-not-resuscitate consent types and end-of-life treatments. : A total of 275 patients were included, in which 21% signed their do-not-resuscitate consents. A total of 233 patients were followed until death, and 32% of the decedents continued hemodialysis, 75% underwent nasogastric (NG) tube placement, and 70% took antibiotics in their final seven days of life. Do-not-resuscitate consents signed by patients were associated with reduced life-prolonging treatments including feeding tube placement and antibiotic use in the last seven days (odd ratio and 95% confidence interval were 0.16, 0.07-0.34 and 0.33, 0.16-0.69, respectively) compared to do-not-resuscitate consents signed by surrogates. Do-not-resuscitate consent signed by patients and not by surrogates may reflect better patients' autonomy and reduced life-prolonging treatments in the final seven days of patients with advanced kidney disease.
患者患有晚期肾脏疾病，存在症状和心理负担，需要进行肾脏支持治疗或姑息治疗。然而，在这些患者中，拒绝复苏同意类型（由患者或代理人签署）对临终治疗的影响仍不清楚。
我们旨在确定与晚期肾脏疾病患者不同拒绝复苏同意类型相关的影响因素，以及拒绝复苏同意类型对各种延长生命治疗的影响。这是一项回顾性观察研究。我们纳入了 20 岁及以上、被诊断为晚期肾脏疾病并在台湾一家三级教学医院接受姑息治疗和临终关怀咨询服务的患者。我们回顾了病历，并使用逻辑回归来确定与拒绝复苏同意类型和临终治疗相关的因素。
共有 275 名患者入组，其中 21%签署了拒绝复苏同意书。共有 233 名患者接受了随访直至死亡，32%的死者继续进行血液透析，75%进行了鼻胃管（NG）管放置，70%在生命的最后 7 天内使用了抗生素。与由代理人签署的拒绝复苏同意书相比，由患者签署的拒绝复苏同意书与减少生命延长治疗有关，包括在生命的最后 7 天内放置喂养管和使用抗生素（比值比和 95%置信区间分别为 0.16、0.07-0.34 和 0.33、0.16-0.69）。
由患者签署而非代理人签署的拒绝复苏同意书可能反映了晚期肾脏疾病患者在生命的最后 7 天内更好的患者自主性和减少的生命延长治疗。
