title: Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea.
abstract: OBJECTIVE
  To examine the current practices relating to do-not-resuscitate (DNR) orders for terminal patients with cancer at teaching hospitals in Korea.
  
  
  METHODS
  The records of 387 deaths from January 1 to December 31, 2005 at four cancer centers were identified and reviewed to assess the DNR delineation. Basic demographics, circumstances surrounding the establishment of the DNR directive, the percentage of orders for identified populations, and the time interval between DNR consent and death were evaluated.
  
  
  RESULTS
  An order of DNR consent was obtained from 296 patients (76%) of a total of 387 patients. All DNR consents were made between the physician and family, without involving the patient. Written preprinted DNR consent forms were used in 169 (57%) cases and 127 patients (43%) had verbal DNR permission. DNR consent was interpreted in two ways: one forbade resuscitation in two hospitals and the other implied limited care in two other hospitals. A unilateral physician decision to withhold cardiopulmonary resuscitation (CPR) was decided for 62 (16%) patients. Terminal CPR was performed on 29 (7%) patients. DNR discussion was made within 7 days of the day of death on 228 (77%) patient among the 296 DNR consenting patients.
  
  
  CONCLUSIONS
  From our teaching-hospital-based analysis of terminal cancer patients in Korea, consent for a DNR order was common. However, DNR order forms were not standardized and lacked room to document patient involvement in the decision. Usually the DNR decision was made within last days of the patient's life. Our results reflect the need for the improvement of end-of-life care decisions in Korea.
authors.affiliation: Department of Medical Oncology, Dongguk University International Hospitals, Goyang, Gyeonggi, Republic of Korea.
authors.forename: Do Yeun
authors.initials: DY
authors.lastname: Kim
authors.forename: Kyoung Eun
authors.initials: KE
authors.lastname: Lee
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Nam
authors.forename: Hye Ran
authors.initials: HR
authors.lastname: Lee
authors.forename: Keun-Wook
authors.initials: KW
authors.lastname: Lee
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Soon Nam
authors.initials: SN
authors.lastname: Lee
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D016134:Organizational Policy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D019452:Terminally Ill