The Association Between Timing of Do-Not-Resuscitation Decision and Health Care Utilization Among Cancer Decedents

• Main Authors: Chun Fang Wen, 溫純芳
• Other Authors: Wen-der Lin
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/86462253097763725011

碩士 === 長榮大學 === 醫務管理學系碩士班 === 102 === Introduction:Although the ratio of terminal cancer patients who received CPR (Cardiopulmonary Resuscitation) within the last month of their lives were declining annually since the Hospice Palliative Care Regulation had been established more than a decade ago, the aggressiveness in end-of-life care may not reduce accordingly due to late DNR (Do Not Resuscitate) decision. This study aimed to investigate the timing of DNR decision and its impact on the health care utilization of last hospitalization based on the data from a metropolitan teaching hospital in southern Taiwan. Methodology:We retrospectively retrieved chart data for cancer decedents who died between January 1st 2009 and June 30th 2013. After excluding 14 cancer decedents who did not sign up DNR and those who hospitalized less than 3 days, this study collected 473 cancer decedents who had signed DNR as our sample subjects. According to the timing of their DNR decision, they were classified into three groups: before admission DNR(N=181), admission DNR(N=114), post admission DNR(N=178). Among three groups, their demographical characteristics, disease categories and utilization of various intervention were compared by Chi-Square test; while their living days after signing DNR, lengths of stay in the hospital and medical expenditure were compared by Kruskal-Wallis test; Finally, the association between the timing of DNR decision and utilization of various intervention was analyzed by logistic regression models, while the association between the timing of DNR decision and medical expenditure was analyzed by multiple regression models with logarithm transformation on expenditure. Results: Screened from the demographic data, most of the male signed DNR on the day of admission DNR and most the female before admission DNR . On the relationship between the timing of DNR decision and marriage, the married ones became significant (p＜0.01). There are no variance found, considering from the kinds and stages of the cancer on the patients. Admission to the emergency room is the highest place of obvious(p<0.001),The most patient complained was dyspnea((p<0.001). Post admission DNR of opioid analgesics and pastoral care utilization were significantly less than the before admission DNR(p<0.05) ,but the computed tomography(p<0.001) and antibiotics (p<0.05)were relatively more utilized. The timing of DNR decision were relevant (p＜0.001) with the lengths of stay , periods after DNR decision and medical expenditure among those cancer decedents. The factors, which affected health care utilization, are the timing of DNR decision, sex, age, education, cancer stages and cancer kinds. Conclusion: More than 1/3 of cancer decedents made DNR decision late in their last hospitalization and that may result in more aggressive medical intervention and higher medical expenditure. To improve end-of-life quality care, policy to promote early DNR decision may be warranted.