An empirical analysis of the decision-making of limiting life-sustaining treatment for patients with advanced chronic obstructive pulmonary disease in Hong Kong, China.
OBJECTIVE
To understand the prognostic and quality-of-life considerations surrounding life-sustaining treatment decisions for patients with advanced chronic obstructive pulmonary disease (COPD) in Hong Kong China.


METHODS
A documentary review of 49 COPD patients and 19 patient case studies from the medical departments of 2 hospitals were undertaken to examine the practices of DNI decision-making (do not perform mechanical ventilation and cardiopulmonary resuscitation). Statistical, event, and thematic analyses were conducted to delineate the prognostic and quality-of-life factors that shaped the not for intubation and mechanical ventilation (DNI) decisions.


RESULTS
Three major treatment-limiting decision-making patterns existed in practice: 1) Patient-initiated and shared decision-making with physician (n = 14); 2) Physician-initiated and shared decision-making with the patient/family members (n = 24); and 3) Physician-initiated DNI decision-making with patient family, but without patient participation due to mental incapacity (n = 11). Prognostic considerations include physiological parameters, performance status, concomitant diseases, therapeutic regimens, and the utilization of medical services. Three major themes were delineated regarding the way in which the patients evaluated their life quality in the context of DNI status. They are prognostic awareness, illness burdens, and existential concerns.


CONCLUSIONS
A decision-making framework used by patients/families/physicians to limit life-sustaining treatments in patients with advanced COPD is delineated. Observations regarding how treatment limiting decision-making for patients with advanced chronic illnesses can be improved in Hong Kong are discussed.
Pang
Samantha M C
SM
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR. hsspang@inet.polyu.edu.hk
Tse
Chun-yan
CY
Chan
Kin-sang
KS
Chung
Betty P M
BP
Leung
Amanda K A
AK
Leung
Edward M F
EM
Ko
Stanley K K
SK
D000368:Aged; D001293:Attitude to Death; D016887:Cardiopulmonary Resuscitation; D003657:Decision Making; D005190:Family; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D010358:Patient Participation; D010819:Physician's Role; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012121:Respiration, Artificial; D016414:Resuscitation Orders