Determinants of do-not-resuscitate orders in palliative home care.
Female; Humans; Male; Pain Measurement; Adult; Canada; Aged; Middle Aged; Activities of Daily Living; Demography; Case Management; adolescent; 80 and over; retrospective studies; DNAR; Resuscitation Orders; Neuropsychological Tests; Pain/di [Diagnosis]; Advance Directives/sn [Statistics & Numerical Data]; Critical Illness/mo [Mortality]; Critical Illness/th [Therapy]; Palliative Care/sn [Statistics & Numerical Data]; Cognition Disorders/di [Diagnosis]; Cognition Disorders/ep [Epidemiology]; Palliative Care/lj [Legislation & Jurisprudence]
OVERVIEW: Do-not-resuscitate (DNR) orders allow home care clients to communicate their own wishes over medical treatment decisions, helping to preserve their dignity and autonomy. To date, little is known about DNR orders in palliative home care. Basic research to identify rates of completion and determinants of DNR orders has yet to be examined in palliative home care., PURPOSE: The purpose of this exploratory study was to determine who in palliative home care has a DNR order as part of their advance directive., METHODS: Information on health was collected using the interRAI instrument for palliative care (interRAI PC). The sample included 470 home care clients from one community care access centre in Ontario., RESULTS: This study indicated that a preference to die at home (odds ratio [OR]: 8.29, confidence interval [CI]: 4.55-15.11); close proximity to death (OR: 0.99, CI: 0.99-1.00); daily incontinence (OR: 2.74, CI: 1.05-7.16); and sleep problems (OR: 1.85, CI: 1.02-3.37) are associated with DNR orders. In addition, clients who are more accepting of their situation are 5.67 times (CI: 1.67-19.27) more likely to have a DNR in place., CONCLUSION: This study represents an important first step to identifying issues related to DNR orders. In addition to proximity to death, incontinence, and sleep problems, acceptance of one's own situation and a preference to die at home are important determinants of DNR completion. The results imply that these discussions might often depend not only on the health of the clients but also on the clients' acceptance of their current situation and where they wish to die.
2008
Brink P; Smith TF; Kitson M
Journal Of Palliative Medicine
2008
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/jpm.2007.0105" target="_blank" rel="noreferrer">10.1089/jpm.2007.0105</a>
Advance directives and do-not-resuscitate orders in patients with cancer with metastatic spinal cord compression: advanced care planning implications.
Female; Humans; Male; United States; Young Adult; Physician-Patient Relations; Adult; Aged; Middle Aged; Communication; 80 and over; DNAR; Palliative Care/lj [Legislation & Jurisprudence]; Advance Directives/lj [Legislation & Jurisprudence]; Health Planning/lj [Legislation & Jurisprudence]; Neoplasms/pa [Pathology]; Resuscitation Orders/lj [Legislation & Jurisprudence]; Spinal Cord Compression/et [Etiology]; Spinal Cord Compression/pa [Pathology]; Spinal Neoplasms/co [Complications]; Spinal Neoplasms/sc [Secondary]; Palliative Care/ut [Utilization]
OBJECTIVES: Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC., METHODS: We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations., RESULTS: The mean age of this patient population was 55 years (range, 24-81). Thirty patients (33%) were female. Twenty patients (23%) had a living will, 27 patients (31%) had health care proxies, and 10 patients (11%) had either out-of-hospital DNR order and/or dictated DNR note. The median survival time for these patients was 4.3 months., CONCLUSION: Despite strong evidence showing short survival times for MSCC patients, it seems many of these patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-of-life palliative care and suboptimal doctor-patient communication. Using the catastrophic event of a diagnosis of MSCC to trigger communication and initiate palliative care may be beneficial to patients and their families.
2010
Guo Y; Palmer JL; Bianty J; Konzen B; Shin Ki; Bruera E
Journal Of Palliative Medicine
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/jpm.2009.0376" target="_blank" rel="noreferrer">10.1089/jpm.2009.0376</a>