title: Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study.
abstract: Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, and Institute of Public Health, National Yang-Ming University Department of Radiology, Taipei Veterans General Hospital Institute of Clinical Medicine, National Yang-Ming University Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
authors.forename: Hsiao-Ting
authors.initials: HT
authors.lastname: Chang
authors.forename: Ming-Hwai
authors.initials: MH
authors.lastname: Lin
authors.forename: Chun-Ku
authors.initials: CK
authors.lastname: Chen
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000145:classification / Q000401:mortality / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000592:standards / Q000639:trends; D058996:Quality Improvement; D016414:Resuscitation Orders; D013624:Taiwan / Q000453:epidemiology