title: The Association between End-of-Life Care and the Time Interval between Provision of a Do-Not-Resuscitate Consent and Death in Cancer Patients in Korea.
abstract: OBJECTIVE
  We explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea.
  
  
  METHODS
  A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days).
  
  
  RESULTS
  In general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001).
  
  
  CONCLUSIONS
  Earlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.
authors: Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
authors: Sun Kyung
authors: SK
authors: Baek
authors: Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors: Hye Jung
authors: HJ
authors: Chang
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Ja Min
authors: JM
authors: Byun
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Jae Joon
authors: JJ
authors: Han
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Dae Seog
authors: DS
authors: Heo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003643:Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D010343:Patient Admission; D056910:Republic of Korea / Q000453:epidemiology; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care; D055815:Young Adult
keywords: Neoplasms; Resuscitation orders; Terminal care