title: End-of-life care in the general wards of a Singaporean hospital: an Asian perspective.
abstract: BACKGROUND
  Despite international differences in cultural perspectives on end-of-life issues, little is known of the care for the dying in the general wards of acute hospitals in Asia.
  
  
  METHODS
  We performed a retrospective medical chart review of all 683 adult patients who died without intensive care unit (ICU) admission in our Singaporean hospital in 2007. We first evaluated the prevalence of do-not-resuscitate (DNR) orders and orders for or against life-sustaining therapies; second, if such orders were discussed with the patients and/or family members; and third, the actual treatments provided before death.
  
  
  RESULTS
  There were DNR orders for 66.2% of patients and neither commitment for DNR nor cardiopulmonary resuscitation (CPR) for 28.1%. Orders to limit life-sustaining therapies, including ICU admission, intubation, and vasopressors/inotropes were infrequent. Only 6.2% of the alert and conversant patients with DNR orders were involved in discussions on these orders. In contrast, such discussions with their family members occurred 82.9% of the time. Interventions in the last 24 hours of life included CPR (9.4%), intubation (6.4%), vasopressors/inotropes (14.8%), tube feeding (24.7%), and antibiotics (44.9%). Analgesia was provided in 29.1% of patients.
  
  
  CONCLUSIONS
  There was a lack of commitment by doctors on orders for DNR/CPR and to limit life-sustaining therapies, infrequent discussions with patients on end-of-life decisions, and excessive burdensome interventions with inadequate palliative care for the dying. These findings may reflect certain Asian cultural biases. More work is required to improve our quality of end-of-life care.
authors: Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore. jason_phua@nuhs.edu.sg
authors: Jason
authors: J
authors: Phua
authors: Adrian Chin-Leong
authors: AC
authors: Kee
authors: Adeline
authors: A
authors: Tan
authors: Amartya
authors: A
authors: Mukhopadhyay
authors: Kay Choong
authors: KC
authors: See
authors: Ngu Wah
authors: NW
authors: Aung
authors: Angeline S T
authors: AS
authors: Seah
authors: Tow Keang
authors: TK
authors: Lim
mesh_terms: D032722:Advance Care Planning / Q000592:standards / Q000706:statistics & numerical data*; D024362:Advance Directive Adherence / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D001291:Attitude of Health Personnel / Q000208:ethnology; D001293:Attitude to Death / Q000208:ethnology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008020:Life Support Care / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012846:Singapore; D013727:Terminal Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data