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
2
조회
0
다운로드
11
인용
0
참고문헌
키워드
초록
Purpose 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. Materials and 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). Conclusion 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.
Abstract
Purpose 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. Materials and 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). Conclusion 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.
참고문헌 (18)
- Jonsson PV, "The 'Do not resuscitate'order : a profile of its changing use", Arch Intern Med, 148, pp.2373~2375 (1988)
- Rabkin MT, "Orders not to resuscitate", N Engl J Med, 295, pp.364~366 (1976)
- Oh DY, "Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies", Cancer, 100, pp.1961~1966 (2004)
- Kim DY, "Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea", J Palliat Med, 10, pp.1153~1158 (2007)
- Oh DY, "CPR or DNR? End-of-life decision in Korean cancer patients : a single center's experience", Support Care Cancer, 14, pp.103~108 (2006)
- Celso BG, "The triad that matters : palliative medicine, code status, and health care costs", Am J Hosp Palliat Care, 27, pp.398~401 (2010)
- Becker G, "End-of-life care in hospital : current practice and potentials for improvement", J Pain Symptom Manage, 33, pp.711~719 (2007)
- Kasper DL, "Harrison's principles of internal medicine" (2015), McGraw Hill Education Medical
- National Institute for Health and Care Excellence, "Improving supportive and palliative care for adults with cancer" (2004), National Institute for Health and Care Excellence
- Keam B, "Aggressiveness of cancer-care near the end-of-life in Korea", Jpn J Clin Oncol, 38, pp.381~386 (2008)
- Lee JK, "Surrogate decision-making in Korean patients with advanced cancer : a longitudinal study", Support Care Cancer, 21, pp.183~190 (2013)
- National Evidence-based Healthcare Collaboration Agency, "Social consensus for withdrawal of futile life-sustaining treatment" (2009), National Evidence-based Healthcare Collaboration Agency
- 허대석, "Life-Sustaining Medical Treatment for Terminal Patients in Korea", Journal of Korean Medical Science, 28(1), pp.1~3 (2013), 대한의학회
- Gu X, "End-of-life decision-making of terminally ill cancer patients in a tertiary cancer center in Shanghai, China", Support Care Cancer, 24, pp.2209~2215 (2016)
- Tang ST, "Concordance of preferences for end-of-life care between terminally ill cancer patients and their family caregivers in Taiwan", J Pain Symptom Manage, 30, pp.510~518 (2005)
- Andorno R, "Advance health care directives: towards a coordinated European policy", Eur J Health Law, 16, pp.207~227 (2009)
- Teno JM, "Association between advance directives and quality of end-of-life care : a national study", J Am Geriatr Soc, 55, pp.189~194 (2007)
- Ivo K, "A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan", J Med Ethics, 38, pp.310~316 (2012)