title: Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital.
abstract: OBJECTIVE
  The aim of the study was to compare timing and decision-makers of do-not-resuscitate (DNR) orders between patients with end-stage thoracic cancer and non-cancer respiratory diseases in a Japanese acute care hospital.
  
  
  METHODS
  This study retrospectively reviewed the medical records of patients who died between January 2008 and March 2013 in the Department of Respiratory Medicine of Osaka Police Hospital, a teaching and acute care hospital. We compared the decision-making process, especially timing and decision-maker, of DNR orders between patients with thoracic cancer and patients with non-cancer respiratory diseases.
  
  
  RESULTS
  There were 300 cancer patients and 147 non-cancer patients. Cancer patients were significantly younger, were hospitalized more frequently and for longer, were more likely to have a DNR order placed earlier and decided in advance of last admission, and were more likely to have normal cognitive function at the time of the DNR order than non-cancer patients. Spouses of cancer patients were more likely to participate in DNR discussion. Only approximately 6 % of patients participated in DNR discussion in both groups. Cancer patients less frequently received aggressive treatment at the end of life (EOL) and were more likely to die in general wards than in intensive care units.
  
  
  CONCLUSIONS
  Our study found that most Japanese patients, with or without cancer, who died in an acute care respiratory department, were not included in DNR discussions and that familial surrogates usually made the DNR decision at the EOL.
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Seigo
authors.initials: S
authors.lastname: Minami
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ogata
authors.forename: Taro
authors.initials: T
authors.lastname: Koba
authors.forename: Shinji
authors.initials: S
authors.lastname: Futami
authors.forename: Yuh
authors.initials: Y
authors.lastname: Nishijima
authors.forename: Moto
authors.initials: M
authors.lastname: Yaga
authors.forename: Kentaro
authors.initials: K
authors.lastname: Masuhiro
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Komuta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007564:Japan; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000523:psychology* / Q000628:therapy*; D016414:Resuscitation Orders / Q000523:psychology*; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000523:psychology* / Q000628:therapy*; D013997:Time Factors