title: Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients.
abstract: OBJECTIVE
  Discussing end-of-life care with patients is often considered taboo, and signing a do-not-resuscitate (DNR) order is difficult for most patients, especially in Chinese culture. This study investigated distributions and details related to the signing of DNR orders, as well as the completeness of various DNR order forms.
  
  
  METHODS
  Retrospective chart reviews were performed. We screened all charts from a teaching hospital in Taiwan for patients who died of cancer during the period from January 2010 to December 2011. A total of 829 patient records were included in the analysis. The details of the DNR order forms were recorded.
  
  
  RESULTS
  The DNR order signing rate was 99.8%. The percentage of DNR orders signed by patients themselves (DNR-P) was 22.6%, while the percentage of orders signed by surrogates (DNR-S) was 77.2%. The percentage of signed DNR forms that were completely filled out was 78.4%. The percentage of DNR-S forms that were completed was 81.7%, while the percentage of DNR-P forms that were completely filled out was only 67.6%.
  
  
  CONCLUSIONS
  Almost all the cancer patients had a signed DNR order, but for the majority of them, the order was signed by a surrogate. Negative attitudes of discussing death from medical professionals and/or the family members of patients may account for the higher number of signed DNR-S orders than DNR-P orders. Moreover, early obtainment of signed DNR orders should be sought, as getting the orders earlier could promote the quality of end-of-life care, especially in non-oncology wards.
authors: Department of Nursing, National Taiwan University Hospital, Hsinchu Branch, Taiwan.
authors: Kuei-Yen
authors: KY
authors: Wen
authors: Ya-Chin
authors: YC
authors: Lin
authors: Ju-Feng
authors: JF
authors: Cheng
authors: Pei-Chun
authors: PC
authors: Chou
authors: Chih-Hsin
authors: CH
authors: Wei
authors: Yun-Fang
authors: YF
authors: Chen
authors: Jia-Ling
authors: JL
authors: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology / Q000523:psychology*; D003142:Communication; D005190:Family / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality*; D010166:Palliative Care / Q000523:psychology; D016414:Resuscitation Orders / Q000523:psychology*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
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