Do-not-resuscitate consent signed by patients indicates a more favorable quality of end-of-life care for patients with advanced cancer.

Abstract

Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups. We enrolled 1495 patients. The most prevalent primary cancers were hepato-biliary-pancreatic (26.9%), lung (16.3%), and colorectal (14.0%) cancers. We classified 965 (64.5%) and 530 (35.5%) patients into the DNR-S and DNR-P groups, respectively. Significant differences were observed between both groups regarding gender (p=0.002), age (p<0.001), and the Eastern Cooperative Oncology Group performance (p<0.001) and educational (p<0.001) status levels. The median survival times after DNR consent signature were 5.0days (95% confidence interval [CI] 4.4-5.6days) and 14.0days (95% CI 12.1-15.9days) in the DNR-S and DNR-P groups, respectively (p<0.001). The median good death evaluation (GDE) scores were 5.4 (95% CI 4.9-6.0) and 13.7 (95% CI 12.7-14.6) in the DNR-S and DNR-P groups, respectively (p<0.001). Univariate and multivariate analyses revealed that DNR-S was an independent factor for significantly low GDE scores (i.e., poor EOL care quality). The DNR concept is emerging; however, the DNR-P percentage remains low (35.6%) in patients with advanced cancer. DNR-P significantly improves the EOL care quality.