title: Predictive factors for do-not-resuscitate designation among terminally ill cancer patients receiving care from a palliative care consultation service.
abstract: BACKGROUND
  Since the development of palliative care in the 1980s, "do not resuscitate" (DNR) has been promoted worldwide to avoid unnecessary resuscitation in terminally ill cancer patients.
  
  
  OBJECTIVE
  This study aimed to evaluate the effect of a palliative care consultation service (PCCS) on DNR designation and to identify a subgroup of patients who would potentially benefit from care by the PCCS with respect to DNR designation.
  
  
  METHODS
  In total, 2995 terminally ill cancer patients (with a predicted life expectancy of less than six months by clinician estimate) who received care by the PCCS between January 2006 and December 2010 at a single medical center in Taiwan were selected. Among these, the characteristics of 2020 (67.4%) patients who were not designated as DNR at the beginning of care by the PCCS were retrospectively analyzed to identify variables pertinent to DNR designation.
  
  
  RESULTS
  A total of 1301 (64%) of 2020 patients were designated as DNR at the end of care by the PCCS. Male gender and primary liver cancer were characteristics more predominantly found among DNR-designated patients who also had worse performance status, higher prevalence of physical distress, and shorter intervals from palliative care referral to death than did patients without DNR designation. On univariate analysis, a higher probability of DNR designation was associated with male gender, duration of care by the PCCS of more than 14 days, patients' prognostic awareness, family's diagnostic and prognostic awareness, and high Palliative Prognostic Index (PPI) scores. On multivariate analysis, duration of care by the PCCS, patients' prognostic awareness, family's diagnostic and prognostic awareness, and a high PPI score constituted independent variables predicting DNR-designated patients at the end of care by the PCCS.
  
  
  CONCLUSIONS
  DNR designation was late in terminally ill cancer patients. DNR-designated cancer patient indicators were high PPI scores, patients' prognostic awareness, family's diagnostic and prognostic awareness, and longer durations of care by the PCCS.
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Kao
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Department of Nursing, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Shu-Chuan
authors.initials: SC
authors.lastname: Tang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Kuan-Gen
authors.initials: KG
authors.lastname: Huang
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Tang-Her
authors.initials: TH
authors.lastname: Jaing
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Chien-Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Keng-Hao
authors.initials: KH
authors.lastname: Liu
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Shen
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Jin-Hou
authors.initials: JH
authors.lastname: Wu
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Hung
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Hung-Chih
authors.initials: HC
authors.lastname: Hsu
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Chi-Ting
authors.initials: CT
authors.lastname: Liau
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Po-Jung
authors.initials: PJ
authors.lastname: Su
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China. Electronic address: wenchi3992@yahoo.com.tw.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
mesh_terms: D000368:Aged; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care; D011379:Prognosis; D012017:Referral and Consultation; D016414:Resuscitation Orders / Q000523:psychology; D012189:Retrospective Studies; D012737:Sex Factors; D013624:Taiwan; D019452:Terminally Ill / Q000523:psychology; D013997:Time Factors
keywords: Palliative Prognostic Index; Terminal cancer; do-not-resuscitate; palliative care