Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey.
OBJECTIVE
To examine the current status of advance directives (ADs) and do-not-resuscitate (DNR) orders among patients with terminal cancer in palliative care units (PCUs) in Japan.


METHODS
We conducted a retrospective chart review of the last 3 consecutive patients who died in 203 PCUs before November 30, 2010.


RESULTS
The percentages of patients who had ADs during the final hospitalization for cardiopulmonary resuscitation, mechanical ventilation, intravenous fluid administration, tube feeding, antibiotic administration, and who had appointed a health care proxy were 47%, 46%, 42%, 19%, 18%, and 48%, respectively. Seventy-six percent of the patients had a DNR order. Of the patients with decision-making capacity, 68% were involved in the DNR decision.


CONCLUSIONS
These findings may reflect positive changes in patients' attitudes toward ADs, in Japan.
1Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Yoshiyuki
Y
Kizawa
Satoru
S
Tsuneto
Jun
J
Hamano
Hiroka
H
Nagaoka
Takami
T
Maeno
Yasuo
Y
Shima
D016223:Advance Directives; D006801:Humans; D007564:Japan; D009369:Neoplasms; D010166:Palliative Care; D016414:Resuscitation Orders; D012189:Retrospective Studies; D011795:Surveys and Questionnaires