• Cheng Hon-Wai Benjamin HB https://orcid.org/0000-0002-5302-1804 1 Medical Palliative Medicine (MPM) unit, Department of Medicine & Geriatrics, Tuen Mu, Pui-Shan Karen Shek, Ching-Wah Man, Oi-Man Chan, Chun-Hung Chan, Kit-Man Lai, Suk-Ching Cheng, Koon-Sim Fung, W K Lui, Carman Lam, Yuen-Kwan Ng, Wan-To Wong, and Cherry Wong.
• 1 Medical Palliative Medicine (MPM) unit, Department of Medicine & Geriatrics, Tuen Mun Hospital, NT, Hong Kong.
• Am J Hosp Palliat Care. 2019 Sep 1; 36 (9): 760-766.

BackgroundNoncancer 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.ObjectivesWe 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.DesignRetrospective 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.ResultsOver 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%; P = .047) and older (age >75) age group (86.2% vs 66.7%; P = .012). Of the 40 deceased patients, median time from signed directives to death was 5 months. Vast majority (95%) had their DNR directives being honored.ConclusionHealth-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.

40 keywords...

hide…