Learning Objective 1: understand the importance of discussing DNR order in advance.
Learning Objective 2: understand the cultural differences in end-of-life decision making.
Purpose: This study is to examine the characteristics of patients who had DNR and family members involved in making the decisions.
Method: This was a descriptive study. Data were collected by EMR review for all patients who had DNR from January 2007 to September 2007 in one university affiliated hospital in Korea. A total of 145 patients were included. Data were collected from August 1, 2007 to October 31, 2007 after IRB was approved. Data were analyzed using the descriptive statistics.
Results: The average age for DNR patients were 62.6 years. Specific disease associated with DNR orders were cancer (53.8%), brain related disease or problems (13.8%), liver cirrhosis (9.6%), sepsis (8.3%), cardiac disease, and organ failure. The DNR request had been made most of the time when the patients' vital signs or metal status were changed. More than half of the patients were in a comatose state when DNR order was made and only 18.6% was alert. The persons involved with DNR decision were patients' child (38.9%), spouse (20.7%), daughter or son-in-law, and brother or sister. The average time interval from DNR order to death was 4.9 days. DNR consent was obtained by written (53.8%) or verbal and formats used in consent was in various styles.
Conclusions: Opportunities to discuss DNR orders should be offered in advance not only for terminally ill patients but also healthy people. Factors that influence DNR discussion in advance should be identified and obstacles should be minimized. DNR orders must be written (not verbal), and consent forms should be standardized.