Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan
Abstract Background The present study aimed to characterize factors associated with patients issued DNR orders during hospitalization who are discharged alive without any instruction orders by physicians regarding end-of-life treatment, with a focus on the timing of DNR order issuance. Methods In to...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Palliative Care |
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| Online Access: | http://link.springer.com/article/10.1186/s12904-020-00588-z |
| _version_ | 1818487209798402048 |
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| author | Tomoari Mori Katsumi Mori Eisuke Nakazawa Seiji Bito Yoshiyuki Takimoto Akira Akabayashi |
| author_facet | Tomoari Mori Katsumi Mori Eisuke Nakazawa Seiji Bito Yoshiyuki Takimoto Akira Akabayashi |
| author_sort | Tomoari Mori |
| collection | DOAJ |
| description | Abstract Background The present study aimed to characterize factors associated with patients issued DNR orders during hospitalization who are discharged alive without any instruction orders by physicians regarding end-of-life treatment, with a focus on the timing of DNR order issuance. Methods In total, 2997 DNR cases from all 61,037 patients aged ≥20 years admitted to a representative general hospital in Tokyo were extracted and divided into two groups by patient hospital release status (discharged alive/deceased). Study items included age, sex, disease type (non-cancer/cancer), hospital department (internal medicine/others), timing of DNR order issuance, implementation (or not) of life-sustaining treatment (LST) or the presence of any restrictions on LST and hospital length of stay. We conducted multiple logistic regression analysis, setting hospital release status as the dependent variable and each above study item as explanatory variables. Results DNR orders were issued at a rate of 4.9%. The analysis revealed that patients with a DNR who were ultimately discharged alive were statistically more likely to be those for whom DNR orders are issued early after admission (adjusted odds ratio: AOR, 13.7), non-cancer patients (AOR, 3.4), internal medicine department patients (AOR, 1.63), females (AOR, 1.34), and elderly (aged ≥85 years; AOR, 1.02); these patients were also less likely to be receiving LST (AOR, 0.36). Conclusions By focusing on those with DNR orders who were ultimately discharged alive, we discovered that these patients were likely to have DNR orders issued early after admission, and that they were more likely to be elderly, female, non-cancer patients, or those in internal medicine departments. Further examination of these data may help to elucidate why these particular DNR-related characteristics (including socio-economic and cultural factors) are evident in patients who end up being discharged alive. |
| first_indexed | 2024-12-10T16:34:50Z |
| format | Article |
| id | doaj.art-f4acb722c2994bf5be61d0c9a18b872a |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-10T16:34:50Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-f4acb722c2994bf5be61d0c9a18b872a2022-12-22T01:41:27ZengBMCBMC Palliative Care1472-684X2020-06-011911810.1186/s12904-020-00588-zCharacterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in JapanTomoari Mori0Katsumi Mori1Eisuke Nakazawa2Seiji Bito3Yoshiyuki Takimoto4Akira Akabayashi5Department of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of MedicineDepartment of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of MedicineDepartment of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of MedicineDivision of Clinical Epidemiology, National Hospital Organization, Tokyo Medical CenterDepartment of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of MedicineDepartment of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of MedicineAbstract Background The present study aimed to characterize factors associated with patients issued DNR orders during hospitalization who are discharged alive without any instruction orders by physicians regarding end-of-life treatment, with a focus on the timing of DNR order issuance. Methods In total, 2997 DNR cases from all 61,037 patients aged ≥20 years admitted to a representative general hospital in Tokyo were extracted and divided into two groups by patient hospital release status (discharged alive/deceased). Study items included age, sex, disease type (non-cancer/cancer), hospital department (internal medicine/others), timing of DNR order issuance, implementation (or not) of life-sustaining treatment (LST) or the presence of any restrictions on LST and hospital length of stay. We conducted multiple logistic regression analysis, setting hospital release status as the dependent variable and each above study item as explanatory variables. Results DNR orders were issued at a rate of 4.9%. The analysis revealed that patients with a DNR who were ultimately discharged alive were statistically more likely to be those for whom DNR orders are issued early after admission (adjusted odds ratio: AOR, 13.7), non-cancer patients (AOR, 3.4), internal medicine department patients (AOR, 1.63), females (AOR, 1.34), and elderly (aged ≥85 years; AOR, 1.02); these patients were also less likely to be receiving LST (AOR, 0.36). Conclusions By focusing on those with DNR orders who were ultimately discharged alive, we discovered that these patients were likely to have DNR orders issued early after admission, and that they were more likely to be elderly, female, non-cancer patients, or those in internal medicine departments. Further examination of these data may help to elucidate why these particular DNR-related characteristics (including socio-economic and cultural factors) are evident in patients who end up being discharged alive.http://link.springer.com/article/10.1186/s12904-020-00588-zDo not resuscitate (DNR) orderRetrospective studyOutcomeTimingGeneral hospitalJapan |
| spellingShingle | Tomoari Mori Katsumi Mori Eisuke Nakazawa Seiji Bito Yoshiyuki Takimoto Akira Akabayashi Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan BMC Palliative Care Do not resuscitate (DNR) order Retrospective study Outcome Timing General hospital Japan |
| title | Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan |
| title_full | Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan |
| title_fullStr | Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan |
| title_full_unstemmed | Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan |
| title_short | Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan |
| title_sort | characterizing patients issued dnr orders who are ultimately discharged alive a retrospective observational study in japan |
| topic | Do not resuscitate (DNR) order Retrospective study Outcome Timing General hospital Japan |
| url | http://link.springer.com/article/10.1186/s12904-020-00588-z |
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