ArticleBMC palliative care2022
Factors influencing terminal cancer patients' autonomous DNR decision: a longitudinal statutory document and clinical database study.
Article in BMC palliative care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
9 citing papers in PubMed, 16 citations in OpenAlex.
- Exploring barriers and facilitators to shared decision-making for older adults in East Asian health systems: a scoping review.Innovation in aging · 2026Review
- "Don't need resuscitate" in palliative care: Ethical challenge or obstacle to a good death.Asia-Pacific journal of oncology nursing · 2025Article
- Do not attempt cardiopulmonary resuscitation decision-making process: scoping review.BMJ supportive & palliative care · 2025Article
- Do not attempt cardiopulmonary resuscitation practice and policy in Ireland: a mixed-methods study of service user and advocacy group perspectives.Health research policy and systems · 2025Article
- Pediatric Oncology Hospice: A Comprehensive Review.The American journal of hospice & palliative care · 2024Review
- The death education needs of patients with advanced cancer: a qualitative research.BMC palliative care · 2024Article
- Observational
- Attitudes toward End-of-Life Resuscitation: A Psychometric Evaluation of a Novel Attitude Scale.Healthcare (Basel, Switzerland) · 2023Article
- Patient and hospital characteristics associated with do-not-resuscitate/do-not-intubate orders: a cross-sectional study based on the Taiwan stroke registry.BMC palliative care · 2023Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveMuch of our knowledge of patient autonomy of DNR (do-not-resuscitate) is derived from the cross-sectional questionnaire surveys. Using signatures on statutory documents and medical records, we analyzed longitudinal data to understand the fact of terminal cancer patients' autonomous DNR decision-making in Taiwan.
methodsUsing the medical information system database of one public medical center in Taiwan, we identified hospitalized cancer patients who died between Jan. 2017 and Dec. 2018, collected their demographic and clinical course data and records of their statutory DNR document types, letter of intent (DNR-LOI) signed by the patient personally and the consent form signed by their close relatives.
resultsWe identified 1,338 signed DNR documents, 754 (56.35%) being DNR-LOI. Many patients had the first DNR order within their last week of life (40.81%). Signing the DNR-LOI was positively associated with being under the care of a family medicine physician prior to death at last hospitalization and having hospice palliative care and negatively associated with patient age ≥ 65 years, no formal education, having ≥ 3 children, having the first DNR order to death ≤ 29 days, and the last admission in an intensive care unit.
conclusionsA substantial proportion of terminal cancer patients did not sign DNR documents by themselves. It indicates they may not know their actual terminal conditions and lose the last chance to grasp time to express their life values and wishes. Medical staff involving cancer patient care may need further education on the legal and ethical issues revolving around patient autonomy and training on communicating end-of-life options with the patients. We suggest proactively discussing DNR decision issues with terminal cancer patients no later than when their estimated survival is close to 1 month.
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Registered trials
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