Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea.
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.
Kim
Do Yeun
DY
Department of Medical Oncology, Dongguk University International Hospitals, Goyang, Gyeonggi, Republic of Korea.
Lee
Kyoung Eun
KE
Nam
Eun Mi
EM
Lee
Hye Ran
HR
Lee
Keun-Wook
KW
Kim
Jee Hyun
JH
Lee
Jong Seok
JS
Lee
Soon Nam
SN
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