title: Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department.
abstract: OBJECTIVE
  The purpose of this study was to investigate the prevalence of do-not-resuscitate (DNR) orders and to identify relevant factors influencing the DNR decision-making process by patients' surrogates in the emergency department (ED).
  
  
  METHODS
  A prospective, descriptive, and correlational research design was adopted. A total of 200 surrogates of cancer or non-cancer terminal patients, regardless of whether they signed a DNR order, were recruited as subjects after physicians of the emergency department explained the patient's conditions, advised on withholding medical treatment, and provided information on palliative care to all surrogates.
  
  
  RESULTS
  Of the 200 surrogates, 23 % signed a DNR order for the patients. The demographic characteristics of patients and surrogates, the level of understanding of DNR orders, and factors of the DNR decision had no significant influence on the DNR decision. However, greater severity of disease (odds ratio (OR) = 1.38; 95 % confidence interval (CI) = 0.95-1.74), physician's initiative in discussing with the families (OR = 1.42; 95 % CI = 1.21-1.84), and longer length of hospital stay (OR = 1.06; 95 % CI = 1.03-1.08) were contributing factors affecting patient surrogates' DNR decisions.
  
  
  CONCLUSIONS
  The findings of this study indicated that surrogates of patients who were more severe in disease condition, whose physicians initiated the discussion of palliative care, and who stayed longer in hospital were important factors affecting the surrogates' DNR decision-making. Therefore, early initiation of DNR discussions is suggested to improve end-of-life care.
authors.affiliation: Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833, Taiwan.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Cheng
authors.affiliation: Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: Jing-Jy
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of medicine, Taiwan, Kaohsiung, Taiwan.
authors.forename: Kuan-Han
authors.initials: KH
authors.lastname: Wu
authors.affiliation: Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833, Taiwan.
authors.forename: Shan
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833, Taiwan.
authors.forename: Mei- Ling
authors.initials: ML
authors.lastname: Kuo
authors.affiliation: Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung, 833, Taiwan. jawhuey.su@gmail.com.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Su
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000941:ethics / Q000523:psychology; D011368:Professional-Family Relations; D011446:Prospective Studies; D011788:Quality of Life; D016414:Resuscitation Orders / Q000941:ethics / Q000523:psychology; D013624:Taiwan; D028761:Withholding Treatment
keywords: Do-not-resuscitate (DNR) decision; Emergency department; Palliative care; Surrogate