Dealing With Death Taboo: Discussion of Do-Not-Resuscitate Directives With Chinese Patients With Noncancer Life-Limiting Illnesses.
Adult
Advance Directives
/ ethnology
Age Factors
Aged
Aged, 80 and over
Asian People
/ psychology
Attitude to Death
/ ethnology
Cardiovascular Diseases
/ psychology
Cultural Competency
Decision Making
Family
Female
Hong Kong
Humans
Kidney Failure, Chronic
/ psychology
Male
Middle Aged
Motor Neuron Disease
/ psychology
Palliative Care
/ psychology
Resuscitation Orders
/ psychology
Retrospective Studies
Socioeconomic Factors
Terminal Care
/ psychology
Time Factors
Chinese
Hong Kong
advance care planning
advance directive
death education
do-not-resuscitate (DNR)
end-of-life
palliative
Journal
The American journal of hospice & palliative care
ISSN: 1938-2715
Titre abrégé: Am J Hosp Palliat Care
Pays: United States
ID NLM: 9008229
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
pubmed:
13
2
2019
medline:
30
1
2020
entrez:
13
2
2019
Statut:
ppublish
Résumé
Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation performed and less do-not-resuscitate (DNR) orders in place. Nevertheless, death is still often a taboo across Chinese culture, and ethnic disparities could negatively affect DNR directives completion rates. We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multidisciplinary team approach. Retrospective chart review of all noncancer patients with life-limiting diseases referred to palliative specialist clinic at a tertiary hospital in Hong Kong over a 4-year period. Over the study period, a total of 566 noncancer patients were seen, 119 of them completed their own DNR directives. Patients had a mean age of 74.9. Top 3 diagnoses were chronic renal failure (37%), congestive heart failure (16%), and motor neuron disease (11%). Forty-two percent of patients signed their DNR directives at first clinic attendance. Most Chinese patients (76.5%) invited family caregivers at DNR decision-making, especially for female gender (84.4% vs 69.1%; Health-care workers should be sensitive toward the cultural influence during advance care planning. Role of family for ethnic Chinese remains crucial and professionals should respect this family oriented decision-making.
Sections du résumé
BACKGROUND
BACKGROUND
Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation performed and less do-not-resuscitate (DNR) orders in place. Nevertheless, death is still often a taboo across Chinese culture, and ethnic disparities could negatively affect DNR directives completion rates.
OBJECTIVES
OBJECTIVE
We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multidisciplinary team approach.
DESIGN
METHODS
Retrospective chart review of all noncancer patients with life-limiting diseases referred to palliative specialist clinic at a tertiary hospital in Hong Kong over a 4-year period.
RESULTS
RESULTS
Over the study period, a total of 566 noncancer patients were seen, 119 of them completed their own DNR directives. Patients had a mean age of 74.9. Top 3 diagnoses were chronic renal failure (37%), congestive heart failure (16%), and motor neuron disease (11%). Forty-two percent of patients signed their DNR directives at first clinic attendance. Most Chinese patients (76.5%) invited family caregivers at DNR decision-making, especially for female gender (84.4% vs 69.1%;
CONCLUSION
CONCLUSIONS
Health-care workers should be sensitive toward the cultural influence during advance care planning. Role of family for ethnic Chinese remains crucial and professionals should respect this family oriented decision-making.
Identifiants
pubmed: 30744386
doi: 10.1177/1049909119828116
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM