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Early and late do-not-resuscitate (DNR) decisions in patients with terminal COPD: a retrospective study in the last year of life.

Abstract：

Purpose:The unpredictable trajectory of COPD can present challenges for patients when faced with a decision regarding a do-not-resuscitate (DNR) directive. The current retrospective analysis was conducted to investigate factors associated with an early DNR decision (prior to last hospital admission) and differences in care patterns between patients who made DNR directives early vs late. Patients and methods:Electronic health records (EHR) were reviewed from 271 patients with terminal COPD who died in a teaching hospital in Taiwan. Clinical parameters, patterns of DNR decisions, and medical utilization were obtained. Those patients who had a DNR directive earlier than their last (terminal) admission were defined as "Early DNR" (EDNR). Results:A total of 234 (86.3%) patients died with a DNR directive, however only 30% were EDNR. EDNR was associated with increased age (OR=1.07; 95% CI: 1.02-1.12), increased ER visits (OR=1.22; 95% CI: 1.10-1.37), rapid decline in lung function (OR=3.42; 95% CI: 1.12-10.48), resting heart rate ≥100 (OR=3.02; 95% CI: 1.07-8.51), and right-sided heart failure (OR=2.38; 95% CI: 1.10-5.19). The median time period from a DNR directive to death was 68.5 days in EDNR patients and 5 days in "Late DNR" (LDNR) patients, respectively (P<0.001). EDNR patients died less frequently in the intensive care unit (P<0.001), received less frequent mechanical ventilation (MV; P<0.001), more frequent non-invasive MV (P=0.006), and had a shorter length of hospital stay (P=0.001). Conclusions:Most patients with terminal COPD had DNR directives, however only 30% of DNR decisions were made prior to their last (terminal) hospital admission. Further research using these predictive factors obtained from EHR systems is warranted in order to better understand the relationship between the timing associated with DNR directive decision making in patients with terminal COPD.

journal_name

Int J Chron Obstruct Pulmon Dis

journal_title

International journal of chronic obstructive pulmonary disease

authors

Fu PK,Tung YC,Wang CY,Hwang SF,Lin SP,Hsu CY,Chen DR

doi

10.2147/COPD.S168049

subject

Has Abstract

pub_date

2018-08-14 00:00:00

pages

2447-2454

eissn

1176-9106

issn

1178-2005

pii

copd-13-2447

journal_volume

pub_type

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Early and late do-not-resuscitate (DNR) decisions in patients with terminal COPD: a retrospective study in the last year of life.