Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-11T03:35:56.005Z Has data issue: false hasContentIssue false
  • English
  • Français

The effects of the interventions on the DNR designation among cancer patients: A systematic review

Published online by Cambridge University Press:  18 June 2018

Li-Ting Chen  and
Fei-Hsiu Hsiao
Li-Ting Chen
Affiliation:
Department of Nursing, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
Fei-Hsiu Hsiao*
Affiliation:
School of Nursing, College of Medicine, National Taiwan University, Nursing Department, National Taiwan University Hospital, Taipei, Taiwan
*
Author for correspondence: Fei-Hsiu Hsiao, School of Nursing, College of Medicine, National Taiwan University, National Taiwan University Hospital, No. 1, Jen-Ai Road. Sec. 1, Taipei, Taiwan. E-mail: hsiaofei@ntu.edu.tw
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aims of this systematic review were to examine the effects of the overall and the different types of the interventions on the do-not-resuscitate (DNR) designation and the time between DNR and death among cancer patients.

Method:

Data were searched from the databases of PubMed, CINAHL, EMbase, Medline, and Cochrane Library through 2 November 2017. Studies were eligible for inclusion if they were (1) randomized control trails, quasi-experimental study, and retrospective observational studies and (2) used outcome indicators of DNR designation rates. The Effective Public Health Practice Project tool was used to assess the overall quality of the included studies.

Result:

The 14 studies with a total of 7,180 participants were included in this review. There were 78.6% (11 of 14) studies that indicated that the interventions could improve the DNR designation rates. Three types of DNR interventions were identified in this review: palliative care unit service, palliative consultation services, and patient-physician communication program. The significant increases of the time between DNR designation and death only occurred in a patient-physician communication program.

Significance of results:

The palliative care unit service provided a continuing care model to reduce unnecessary utilization of healthcare service. The palliative consultation service is a new care model to meet the needs of cancer patients in non-palliative care unit. The share decision-making communication program and physician's compassion attitudes facilitate to make DNR decision early. The individualized DNR program needs to be developed according to the needs of cancer patients.

Keywords

Do not resuscitateDNRcancerend-of-life decision-making
Type
Review Article
Information
Palliative & Supportive Care , Volume 17 , Issue 1 , February 2019 , pp. 95 - 106
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Azad, AA et al. (2014) Discharge patterns, survival outcomes, and changes in clinical management of hospitalized adult patients with cancer with a do-not-resuscitate order. Journal of Palliative Medicine 17(7), 776–781.Google Scholar
Bailey, FA et al. (2012) Opioid pain medication orders and administration in the last days of life. Journal of Pain and Symptom Management 44(5), 681–691.Google Scholar
Bell, CL, Kuriya, M and Fischberg, D (2011) Hospice referrals and code status: outcomes of inpatient palliative care consultations among Asian Americans and Pacific Islanders with cancer. Journal of Pain and Symptom Management 42(4), 557–564.Google Scholar
Bone, AE et al. (2016) Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders. Age and Ageing 45(6), 863–873.Google Scholar
Cheng, MT et al. (2016). Increased rate of DNR status in hospitalized end-of-life patients in Taiwan. Intensive Care Medicine 42(11), 1816–1817.Google Scholar
Dahlin, C et al. (2010) Early palliative care for lung cancer: improving quality of life and increasing survival. International Journal of Palliative Nursing 16(9), 420–423.Google Scholar
Delgado-Guay, MO et al. (2009) Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Cancer 115(2), 437–445.Google Scholar
Friedrichsen, M et al. (2017) Palliative care consultation team on acute wards—an intervention study with pre-post comparisons. Supportive Care in Cancer 25(2), 371–380.Google Scholar
Gabriel, E et al. (2017) A formal palliative care service improves the quality of care in patients with stage IV cancer and bowel obstruction. American Journal of Hospice & Palliative Medicine 34(1), 20–25.Google Scholar
Garrido, MM et al. (2015) Quality of life and cost of care at the end of life: The role of advance directives. Journal of Pain and Symptom Management 49(5), 828–835.Google Scholar
Hiraoka, E et al. (2016) What is the true definition of a “Do-Not-Resuscitate” order? A Japanese perspective. International Journal of General Medicine 9, 213–220.Google Scholar
Huang, K-S et al. (2017) The effects of hospice-shared care for gastric cancer patients. PLoS One 12(2), e0171365–e0171365.Google Scholar
Jaul, E, Zabari, Y and Brodsky, J (2014) Spiritual background and its association with the medical decision of, DNR at terminal life stages. Archives of Gerontology and Geriatrics 58(1), 25–29.Google Scholar
Kao, CY et al. (2014) Predictive factors for do-not-resuscitate designation among terminally ill cancer patients receiving care from a palliative care consultation service. Journal of Pain and Symptom Management 47(2), 271–282.Google Scholar
Leeflang, MM et al. (2015) Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database of Systematic Reviews (12):CD0007394. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007394.pub2/abstractGoogle Scholar
Loke, S-S, Rau, K-M and Huang, C-F (2011) Impact of combined hospice care on terminal cancer patients. Journal of Palliative Medicine 14(6), 683–687.Google Scholar
Mori, M et al. (2015) A National survey to systematically identify factors associated with oncologists’ attitudes toward end-of-life discussions: What determines timing of end-of-life discussions? The Oncologist 20(11), 1304–1311.Google Scholar
National Cancer Institute (2016) Palliative care in cancer. Retrieved from https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet#q3Google Scholar
Osinski, A et al. (2017) Do-not-resuscitate orders in cancer patients: a review of literature. Supportive Care in Cancer 25(2), 677–685.Google Scholar
Pagis, M, Tal, O and Cadge, W (2017) What do non-clergy spiritual care providers contribute to end of life care in Israel? A qualitative study. Journal of Religious Health 56(2), 614–622.Google Scholar
Peltier, WL et al. (2017) Initial experience with ‘Honoring Choices Wisconsin’: Implementation of an advance care planning pilot in a tertiary care setting. Journal of Palliative Medicine 20(9), 998–1003.Google Scholar
Perrin, KO and Kazanowski, M (2015) Overcoming barriers to palliative care consultation. Critical Care Nurse 35(5), 44–52.Google Scholar
Rhondali, W et al. (2013) Patient-physician communication about code status preferences: A randomized controlled trial. Cancer 119(11), 2067–2073.Google Scholar
Sato, K et al. (2008) Quality of end-of-life treatment for cancer patients in general wards and the palliative care unit at a regional cancer center in Japan: A retrospective chart review. Support Care Cancer 16(2), 113–122.Google Scholar
Schlairet, MC and Cohen, RW (2013) Allow-natural-death (AND) orders: Legal, ethical, and practical considerations. HEC Forum 25(2), 161–171.Google Scholar
Sean, OM et al. (2009) Preliminary report of the integration of a palliative care team into an intensive care unit. Palliative Medicine 24(2), 154–165.Google Scholar
Shuman, AG et al. (2013) Clinical ethics consultation in patients with head and neck cancer. Head and Neck 35(11), 1647–1651.Google Scholar
Stein, RA et al. (2013) Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. Journal of Clinical Oncology 31(27), 3403–3410.Google Scholar
Syed, AA et al. (2016) Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study. Palliative Medicine 31(2), 147–157.Google Scholar
Thomas, BH et al. (2004) A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing 1(3), 176–184.Google Scholar
Tse, DMW et al. (2007) The impact of palliative care on cancer deaths in Hong Kong: A retrospective study of 494 cancer deaths. Palliative Medicine 21(5), 425–433.Google Scholar
Wang, Z et al. (2016) Do-not-resuscitate orders among advanced-stage Chinese lung cancer patients who died in hospital. Supportive Care in Cancer 24(4), 1763–1769.Google Scholar
Wen, KY et al. (2013) Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients. Supportive Care in Cancer 21(9), 2593–2598.Google Scholar
Wiesenthal, A, Goldman, DA and Korenstein, D (2017) Impact of palliative medicine involvement on end-of-life services for patients with cancer with in-hospital deaths. Journal of Oncology Practice 13(9), e749–e759.Google Scholar
Wu, LF et al. (2016) Relationship between palliative care consultation service and end-of-life outcomes. Supportive Care in Cancer 24(1), 53–60.Google Scholar
Yang, GM, Kwee, AK and Krishna, L (2012) Should patients and family be involved in “do not resuscitate” decisions? Views of oncology and palliative care doctors and nurses. Indian Journal of Palliative Care 18(1), 52–58.Google Scholar
Yang, GM et al. (2016) Effectiveness of hospital palliative care teams for cancer inpatients: A systematic review. Journal of Palliative Medicine 19(11), 1156–1165.Google Scholar
Yuen, JK, Reid, MC and Fetters, MD (2011) Hospital do-not-resuscitate orders: Why they have failed and how to fix them. Journal of General Internal Medicine 26(7), 791–797.Google Scholar