title: Do-not-resuscitate orders among advanced-stage Chinese lung cancer patients who died in hospital.
abstract: OBJECTIVE
  Do-not-resuscitate (DNR) orders are an important part of end-of-life care (EOL) for patients with incurable advanced lung cancer. The aim of this study was to investigate the clinical factors related to the acceptance of DNR orders by Chinese patients.
  
  
  METHODS
  This study was a retrospective analysis involving patients with advanced-stage (IIIB or IV) lung cancer who died in hospital at our center from August 2004 through August 2014. The patients' clinical characteristics and DNR forms were reviewed.
  
  
  RESULTS
  Of the 348 patients enrolled, 260 (74.7 %) provided DNR orders signed only by surrogates. The signing rate of DNR orders increased annually. The median interval from signing a DNR order to death was 1 day (range, 0-72 days). Patients with poor performance status (PS) (≥2) 1 week prior to death (OR, 3.395; 95 % CI, 1.536-7.502, P = 0.003) and relatively longer overall survival (OS) (>3 months) (OR, 2.464; 95 % CI, 1.566-4.472, P < 0.001) were more likely to sign DNR orders. CPR was performed on 10.3 % (27/260) of patients with DNR orders, and was withheld in 22.7 % (20/88) of patients without DNR orders.
  
  
  CONCLUSIONS
  The DNR order-signing rate has been increasing annually among terminal patients with lung cancer in China. DNR orders, all of which were signed by surrogates, were more likely to be accepted by patients with slowly deteriorating disease and longer OS. More effort should be taken to help patients and medical professionals establish a sensible understanding of EOL care, including DNR orders, at earlier points during the disease course.
authors.affiliation: Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China.
authors.forename: Yang-Si
authors.initials: YS
authors.lastname: Li
authors.affiliation: Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhao
authors.affiliation: Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China.
authors.forename: Jin-Ji
authors.initials: JJ
authors.lastname: Yang
authors.affiliation: Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Tu
authors.affiliation: Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou, 510080, China. syylwu@live.cn.
authors.forename: Yi-Long
authors.initials: YL
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology; D001293:Attitude to Death; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002681:China; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D016414:Resuscitation Orders / Q000523:psychology*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D028761:Withholding Treatment / Q000706:statistics & numerical data
keywords: Do-not-resuscitate; End-of-life care; Lung cancer