title: The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan: An Observational Study.
abstract: Prior studies have demonstrated important implications related to religiosity and a do-not-resuscitate (DNR) decision. However, the association between patients' religious background and DNR decisions is vague. In particular, the association between the religious background of Buddhism/Daoism and DNR decisions has never been examined. The objective of this study was to examine the association between patients' religious background and their DNR decisions, with a particular focus on Buddhism/Daoism.The medical records of the patients who were admitted to the 3 surgical intensive care units (SICU) in a university-affiliated medical center located at Northern Taiwan from June 1, 2011 to December 31, 2013 were retrospectively collected. We compared the clinical/demographic variables of DNR patients with those of non-DNR patients using the Student t test or χ test depending on the scale of the variables. We used multivariate logistic regression analysis to examine the association between the religious backgrounds and DNR decisions.A sample of 1909 patients was collected: 122 patients had a DNR order; and 1787 patients did not have a DNR order. Old age (P = 0.02), unemployment (P = 0.02), admission diagnosis of "nonoperative, cardiac failure/insufficiency" (P = 0.03), and severe acute illness at SICU admission (P < 0.01) were significantly associated with signing of DNR orders. Patients' religious background of Buddhism/Daoism (P = 0.04), married marital status (P = 0.02), and admission diagnosis of "postoperative, major surgery" (P = 0.02) were less likely to have a DNR order written during their SICU stay. Furthermore, patients with poor social support, as indicated by marital and working status, were more likely to consent to a DNR order during SICU stay.This study showed that the religious background of Buddhism/Daoism was significantly associated with a lower likelihood of consenting to a DNR, and poor social support was significantly associated with a higher likelihood of having a DNR order written during SICU stay.
authors.affiliation: From the Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine (K-HL, C-CW, Y-YC); and Department of Surgery, National Taiwan University College of Medicine, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan (Y-SC, N-KC, S-JH).
authors.forename: Kuan-Han
authors.initials: KH
authors.lastname: Lin
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.forename: Nai-Kuan
authors.initials: NK
authors.lastname: Chou
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
authors.forename: Chau-Chung
authors.initials: CC
authors.lastname: Wu
authors.forename: Yen-Yuan
authors.initials: YY
authors.lastname: Chen
mesh_terms: D002016:Buddhism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012068:Religion and Medicine; D016414:Resuscitation Orders / Q000523:psychology; D012189:Retrospective Studies; D012944:Social Support; D013624:Taiwan
references.citation: J Adv Nurs. 2007 May;58(3):256-62
references.pmid: 17474914
references.citation: J Formos Med Assoc. 2010 Mar;109(3):201-8
references.pmid: 20434028
references.citation: J Crit Care. 2009 Jun;24(2):311-5
references.pmid: 19327284
references.citation: Crit Care Med. 2011 May;39(5):1036-41
references.pmid: 21336133
references.citation: Arch Gerontol Geriatr. 2014 Jan-Feb;58(1):25-9
references.pmid: 24029615
references.citation: Am J Crit Care. 1994 Nov;3(6):467-72
references.pmid: 7834009
references.citation: Crit Care Med. 2014 Oct;42(10):2188-96
references.pmid: 24810524
references.citation: J Palliat Med. 2011 Jan;14(1):45-50
references.pmid: 21194303
references.citation: Lancet Neurol. 2004 Jun;3(6):343-53
references.pmid: 15157849
references.citation: J Pain Symptom Manage. 2012 Dec;44(6):843-51
references.pmid: 22727947
references.citation: Arch Intern Med. 2004 Jul 26;164(14):1514-8
references.pmid: 15277281
references.citation: Can J Anaesth. 2004 Dec;51(10):1034-41
references.pmid: 15574557
references.citation: J Soc Work End Life Palliat Care. 2013;9(2-3):209-25
references.pmid: 23777235
references.citation: CMAJ. 2000 Nov 28;163(11):1481-5
references.pmid: 11192658
references.citation: J Med Ethics. 2008 May;34(5):336-40
references.pmid: 18448711
references.citation: Support Care Cancer. 2013 Sep;21(9):2593-8
references.pmid: 23653012
references.citation: Chest. 2009 Jun;135(6):1634-1642
references.pmid: 19497898
references.citation: Nurs Ethics. 2011 Nov;18(6):802-13
references.pmid: 21974942
references.citation: Crit Care Med. 1974 Mar-Apr;2(2):57-60
references.pmid: 4832281
references.citation: J Clin Oncol. 2009 Aug 20;27(24):3964-8
references.pmid: 19470919
references.citation: Scand J Trauma Resusc Emerg Med. 2012 May 25;20:36
references.pmid: 22632100
references.citation: N Engl J Med. 1976 Aug 12;295(7):364-6
references.pmid: 934225
references.citation: J Trauma. 2008 Jan;64(1):81-8; discussion 88-91
references.pmid: 18188103
references.citation: J Palliat Med. 2005;8 Suppl 1:S70-8
references.pmid: 16499471
references.citation: BMC Med Ethics. 2014 Mar 04;15:21
references.pmid: 24592981
references.citation: JAMA. 1974 Feb 18;227(7):Suppl:864-8
references.pmid: 4405914
references.citation: J Am Geriatr Soc. 2003 Jun;51(6):835-40
references.pmid: 12757572
references.citation: Resuscitation. 2006 Dec;71(3):322-6
references.pmid: 17064837
references.citation: Crit Care Med. 1985 Oct;13(10):818-29
references.pmid: 3928249
references.citation: J Am Geriatr Soc. 2002 Dec;50(12):2057-61
references.pmid: 12473020
references.citation: J Behav Med. 2006 Aug;29(4):377-87
references.pmid: 16758315
references.citation: J Palliat Med. 2012 Jul;15(7):751-9
references.pmid: 22536938
references.citation: J Med Philos. 1998 Dec;23(6):581-600
references.pmid: 10190842
references.citation: Am J Epidemiol. 1982 Jan;115(1):92-106
references.pmid: 7055134
references.citation: Radiology. 1982 Apr;143(1):29-36
references.pmid: 7063747
references.citation: J Pain Symptom Manage. 2005 Dec;30(6):510-8
references.pmid: 16376737
references.citation: Arch Intern Med. 2010 Sep 27;170(17):1533-40
references.pmid: 20876403
references.citation: Nurs Ethics. 2010 Jul;17(4):445-55
references.pmid: 20610578
references.citation: J Med Ethics. 1999 Aug;25(4):309-14
references.pmid: 10461593
references.citation: N Engl J Med. 1976 Aug 12;295(7):362-4
references.pmid: 934224
references.citation: Am J Med. 1996 Feb;100(2):128-37
references.pmid: 8629646
references.citation: Pediatr Blood Cancer. 2014 Feb;61(2):265-8
references.pmid: 23940107
references.citation: Intensive Care Med. 2008 Mar;34(3):423-30
references.pmid: 18157484