Do-not-resuscitate orders for critically ill patients in intensive care.
End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients' preferences about DNR are elicited and honored.
Chang
Yuanmay
Y
Shin Kong Wu Ho-Su Memorial Hospital, Taipei Medical University, National Taipei Nursing College & Chinese Culture University, Taiwan.
Huang
Chin-Feng
CF
Lin
Chia-Chin
CC
D000368:Aged; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000941:ethics* / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D016414:Resuscitation Orders / Q000941:ethics*; D013624:Taiwan