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Aim. With the advent of an aging society and the development of end-of-life care, there is an increasing need to understand the older generation's attitude toward end-of-life resuscitation. The study aimed to develop and validate a novel attitude scale toward end-of-life resuscitation in older inpatients. Method. Instrumental development and a psychometric evaluation were used. First, a new attitude scale toward end-of-life resuscitation was formulated from literature views, expert content validity, and face validity. Next, the new scale was evaluated using a principal component analysis and internal consistency reliability in a sample from 106 medical–surgical inpatients in a southern Taiwan hospital 1 enrolled through convenience sampling. Serving as an indicator of concurrent validity, a logistic regression analysis was performed to analyze the association between scores on the scale and intention to discuss end-of-life CPR issues. Results: After being validated by the expert content validity and face validity, a draft of a 20-item scale was created. Throughout the exploratory factor analysis, two items with low factor loadings were removed from the draft scale and an 18-item scale of attitude was generated. This 18-item scale had a three-factor structure that accounted for 64.1% of the total variance; the three components were named 'stress, avoidance, and ignorance', 'a peaceful death', and 'self-determination and ambivalence'. The Cronbach's alpha of the total scale and three components were 0.845, 0.885, 0.879, and 0.857, respectively, which indicated a favorable reliability. Scores on the scale were significantly associated with the intention to discuss end-of-life CPR issues, which also indicated a favorable concurrent validity. Conclusions: A 18-item attitude scale with three factors is a valid scale to measure the attitude toward end-of-life resuscitation. The result provides preliminary evidence of the psychometric properties of the scale. Further research with larger samples or other populations is required. [ABSTRACT FROM AUTHOR]

Aim. With the advent of an aging society and the development of end-of-life care, there is an increasing need to understand the older generation’s attitude toward end-of-life resuscitation. The study aimed to develop and validate a novel attitude scale toward end-of-life resuscitation in older inpatients. Method. Instrumental development and a psychometric evaluation were used. First, a new attitude scale toward end-of-life resuscitation was formulated from literature views, expert content validity, and face validity. Next, the new scale was evaluated using a principal component analysis and internal consistency reliability in a sample from 106 medical–surgical inpatients in a southern Taiwan hospital 1 enrolled through convenience sampling. Serving as an indicator of concurrent validity, a logistic regression analysis was performed to analyze the association between scores on the scale and intention to discuss end-of-life CPR issues. Results: After being validated by the expert content validity and face validity, a draft of a 20-item scale was created. Throughout the exploratory factor analysis, two items with low factor loadings were removed from the draft scale and an 18-item scale of attitude was generated. This 18-item scale had a three-factor structure that accounted for 64.1% of the total variance; the three components were named ‘stress, avoidance, and ignorance’, ‘a peaceful death’, and ‘self-determination and ambivalence’. The Cronbach’s alpha of the total scale and three components were 0.845, 0.885, 0.879, and 0.857, respectively, which indicated a favorable reliability. Scores on the scale were significantly associated with the intention to discuss end-of-life CPR issues, which also indicated a favorable concurrent validity. Conclusions: A 18-item attitude scale with three factors is a valid scale to measure the attitude toward end-of-life resuscitation. The result provides preliminary evidence of the psychometric properties of the scale. Further research with larger samples or other populations is required.

Background: chronic and terminal diseases require holistic therapy that covers the biopsychosocial aspect, and it can be found in palliative therapy. Patients who receive palliative therapy exhibit very diverse profiles. As such, researchers are keen to study the general characteristics of palliative patients. In addition, researchers will also assess the patient’s and their family’s insight that influences the success of the therapy and the impact of estimated survival time in making treatment decisions. Methods: this research used cross-sectional descriptive analytic study and secondary data of 300 palliative patients who consult to Psychosomatic Palliative Team at Dr. Cipto Mangunkusumo Hospital. The data were processed using SPSS version 25. The data processed included: sociodemographic characteristics, length of stay, incidence of death in hospital, DNR cases, the patient’s and their family’s insight, and the impact of estimated survival time on treatment decisions. Results: most palliative patients were women (52.0%) aged 51 - 60 years (27.0%), unemployed (29.0%), and suffered from cancer (55.3%). In addition, the patients were generally treated for less than 1 month (83.6%), died in the hospital (37.3%), and consented to DNR orders (36.7%). These DNR cases are highly correlated to the family’s understanding regarding the prognosis of the patient’s condition (p = 0.022). The family’s understanding of the diagnosis, prognosis, and treatment goals (92.3%, 81.3%, and 87.7%) was better than the patient’s (79.0%, 64.0%, and 69.7%). Furthermore, no link was found between the therapy choice (optimal, withholding, and withdrawing therapies) with the patient’s estimated survival time (p = 0.174). Conclusion: female, elderly, and cancer patients most often get palliative therapy. The consent for DNR orders to palliative patient is notably frequent. Currently, the family’s insight is much better than the patient’s, which means that health care providers need to improve patient education and information. In addition, patients and families generally still opt for optimal therapy despite low estimated survival time.

A patient has the right to make decisions regarding his healthcare and medical care. No other person can make any decision regarding treatment if the patient is still capable of making decisions. He may also make an advance directive specifying his wishes not to continue treatment or to receive any medical interventionfor himself. Advance Medical Directive (AMD) is a document that contains a patient's desire for medical treatment, made in advance when the patient is still capable to make a decision. There is a type of order under the scope of AMD which specifically allows patients to refrain from Cardiopulmonary Resuscitation (CPR). The order is known as Do Not Resuscitate (DNR). The order is not a common practice as it may conflict with the doctor's obligation to provide the best treatment to save his patients. The crucial issue is whether a patient is allowed by the law to make a DNR order. This article aims to analyse the current law on a patient's rights from the perspective of the DNR order. This article employed qualitative method in exploring issues relating to DNR. It is found that DNR is a way of protecting the patient's autonomy. In practice, there should be clear guidelines and provisions of law relating to the DNR order in the health sector. This is important in protecting patients' autonomous right while maintaining a good doctor-patient relationship. Health is a basic right that should be enjoyed by every segment of the society. [ABSTRACT FROM AUTHOR]

Background: Do not resuscitate (DNR) is a controversial ethico-legal issue and there is no legal regulation in Turkey. Evaluating the physicians' views on DNR is critical to the current problems and contributes to legal regulation., Objectives: To examine the views of intensive care unit residents on DNR and the sociocultural and occupational factors affecting them., Methods: The research is a descriptive cross-sectional study. The sample of the study consists of 203 residents of internal medicine working in the intensive care unit in a university hospital. A questionnaire form was used as a data collection tool., Results: 62.6% of the physicians know that there is no legal regulation regarding DNR in Turkey, and 14.3% think that DNR is performed. Female physicians approve of DNR at a higher rate than men (p<0.01). Physicians with more experience in the profession stated that not all patients should be performed cardiopulmonary resuscitation (p<0.01), and DNR should be a right (p<0.05). The vast majority of physicians stated that DNR should be legal (88.1%) and should be included in residency training (85.6%)., Conclusions: It is necessary to establish legal regulations on DNR and implement residency training programs that will ensure the continuous professional development of physicians., Competing Interests: The authors declare no competing interests. All the authors have read and agreed to the final manuscript., (© 2023 Hüseyin GC et al.)

Background: Chinese tradition and culture developed from Taoism, Confucianism, and Buddhism and have influenced ethnic Chinese for thousands of years, particularly thoughts on death. Many ethnic Chinese, particularly older people, refrain from discussing death-related concerns, making it difficult to obtain advance directives, including do-not-resuscitate (DNR) directives, signed independently by older people. This study explored the attitudes of older nursing home residents in Taiwan toward signing their own DNR directives. Methods: This study adopted purposive sampling and collected data through in-depth interviews. The data were analysed using qualitative inductive content analysis, and the study location was a nursing home in Eastern Taiwan. Results: A total of 11participants were recruited from a sample of 12 eligible participants. Most of the older residents in this study refused to make decisions independently regarding DNR directives. Content analysis of the interviews revealed four themes concerning refusing to sign DNR directives independently: not going against nature, accepting the results of cause and effect, viewing the family as a decision-making system, and practising self-effacement. Chinese cultural aspects, including Taoist, Buddhist, and Confucian philosophy, affected the autonomy of the older residents, and they relied on others to make decisions for them. Conclusions: Professionals must respect this family-oriented decision-making thinking of older residents because it reflects personal choice. Otherwise, healthcare providers may play a mediating role in coordinating and communicating between older residents and their families regarding EOL-care-related concerns, replacing the traditional practice of holding a family meeting. [ABSTRACT FROM AUTHOR]

Background: Utilization rates (URs) for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective: The purpose of this study was to establish the ICD UR in central Indiana. Methods: A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) ≤0.35. ICD eligibility and utilization were determined from chart review. Results: We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%–49%). URs were 48% for males (95% CI 34%–61%), 21% for females (95% CI 16%–26%, P = .0002 vs males), 40% for whites (95% CI 27%–53%), and 37% for blacks (95% CI 28%–46%, P = .66 vs whites). Conclusion: ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review. [Copyright &y& Elsevier]

Background & Aims: Patients with cirrhosis who are receiving palliative care and are not eligible for liver transplantation (LT) are often hospitalized multiple times, with lack of expectations or understanding of death and dying. We evaluated how frequently these patients received appropriate and palliative care. Methods: We performed a retrospective study of 102 consecutive adult patients (67% men; mean age, 55 years) who were removed from the list for or declined LT from January 2005 through December 2010 at the University of Alberta, Canada. Patients' medical records were reviewed to determine their access to palliative care and relief of symptoms, the appropriateness of the goals for their care, and their requirements for acute care services. Results: The patients' median Model for End-stage Liver Disease score was 20, and median time from denial of LT to death was 52 days (range, 10–332 days). The most common reasons that patients were removed from the transplant wait list were noncompliance or substance abuse (26%) and severe illness or organ dysfunction (25%). After patients were removed from the list, 17% received renal replacement therapy, and 48% were subsequently admitted to the intensive care unit. Patients spent a median of 14 days (range, 6–33 days) in the hospital after they were removed from the transplant wait list. On the basis of the Edmonton Symptom Assessment System, 65% of patients had evidence of pain, 58% had evidence of nausea, 10% had depression, 36% had anxiety, 48% had dyspnea, and 49% had symptoms of anorexia. Twenty-eight percent of all the patients had documentation of do not resuscitate status on their charts, and only 11% were referred for palliative care. Conclusions: Patients with cirrhosis who have been removed from the wait list for LT are infrequently referred for palliative care (∼10% of cases), although a high percentage have pain or nausea. Goals of care and do not resuscitate status are rarely discussed. Improved planning of goals of care and access to palliative services are required for these patients. [Copyright &y& Elsevier]

Abstract: In recent years personal and clinical dilemmas relating to terminally ill patient-care medical, decisions have increased significantly. Although understanding the patient's medical, nursing and, social background is important, a comprehensive appraisal essential for treating the “whole patient” is, incomplete without a spirituality assessment. Religious beliefs and practices affect medical and health, care decisions and require recognition as a dynamic in coping with suffering, loss, life, and death. Taking a spiritual background obtains information that is meaningful to the patient's life and may, influence the medical decision-making relating to health. A study was undertaken to determine, whether assessing the spiritual background influences medical decisions-making regarding the use of, DNR. The target population was 46 family-member caregivers of non-communicative patients in the Herzog, Hospital Skilled Nursing ward located in Jerusalem. The spiritual assessment questionnaire was the, acronym FICA (faith, importance, community and addressing). Two-thirds of the families were opposed to a determination utilizing do not resuscitate (DNR). Multivariate, analysis of the findings found that only religious affiliation was statistically significant (p =0.003). The doctors recommend DNR in 67% of the cases while the family caregiver accepted this decision in, only 33% of the cases. The hypothesis was verified. People who are perceived as being religious or as being greatly influenced, by faith/spirituality opposed the recommendation implementing DNR. Obtaining a spiritual background assists the physician to understand the patient or family spirituality, facilitates sensitivity to value frameworks and preferences in making medical and health-related, decisions. [Copyright &y& Elsevier]

Abstract: Objective: Adult burn patients who experience in-hospital cardiac arrest (CA) and undergo cardiopulmonary resuscitation (CPR) represent a unique patient population. We believe that they tend to be younger and have the added burden of the burn injury compared to other populations. Our objective was to determine the incidence, causes and outcomes following cardiac arrest (CA) and cardio-pulmonary resuscitation (CPR) within this population. Methods: We conducted a retrospective review at the US Army Institute of Surgical Research (ISR) burn intensive care unit (BICU). Charts from 1st January 2000 through 31st August 2009 were reviewed for study. Data were collected all on adult burn patients who experienced in-hospital CA and CPR either in the BICU or associated burn operating room. Patients undergoing CPR elsewhere in our burn unit were excluded because we could not validate the time of CA since they are not routinely monitored with real-time rhythm strips. The study population included civilian burn patients from the local catchment area and burn casualties from the conflicts in Iraq and Afghanistan, but patients with do-not-resuscitate (DNR) orders were excluded. Results: We found 57 burn patients who had in-hospital CA and CPR yielding an incidence of one or more in-hospital CA of 34 per 1000 admissions (0.34%). Fourteen of these patients (25%) survived to discharge while 43 (75%) died. The most common initial cardiac rhythm was pulseless electrical activity (50.9%). The most common etiology of CA among burn patients was respiratory failure (49.1%). The most significant variable affecting survival to discharge was duration of CPR (P <0.01) with no patient surviving more than 7min of CPR. Conclusions: CPR in burn patients is sometimes effective, and those patients who survive are likely to have good neurological outcomes. However, prolonged CPR times are unlikely to result in return of spontaneous circulation and may be considered futile. Further, those who experience multiple CA are unlikely to survive to discharge. [Copyright &y& Elsevier]

Objectives: The purpose of this study is to develop a method for risk-standardizing hospital survival after cardiac arrest. Background: A foundation with which hospitals can improve quality is to be able to benchmark their risk-adjusted performance against other hospitals, something that cannot currently be done for survival after in-hospital cardiac arrest. Methods: Within the Get With The Guidelines (GWTG)-Resuscitation registry, we identified 48,841 patients admitted between 2007 and 2010 with an in-hospital cardiac arrest. Using hierarchical logistic regression, we derived and validated a model for survival to hospital discharge and calculated risk-standardized survival rates (RSSRs) for 272 hospitals with at least 10 cardiac arrest cases. Results: The survival rate was 21.0% and 21.2% for the derivation and validation cohorts, respectively. The model had good discrimination (C-statistic 0.74) and excellent calibration. Eighteen variables were associated with survival to discharge, and a parsimonious model contained 9 variables with minimal change in model discrimination. Before risk adjustment, the median hospital survival rate was 20% (interquartile range: 14% to 26%), with a wide range (0% to 85%). After adjustment, the distribution of RSSRs was substantially narrower: median of 21% (interquartile range: 19% to 23%; range 11% to 35%). More than half (143 [52.6%]) of hospitals had at least a 10% positive or negative absolute change in percentile rank after risk standardization, and 50 (23.2%) had a ≥20% absolute change in percentile rank. Conclusions: We have derived and validated a model to risk-standardize hospital rates of survival for in-hospital cardiac arrest. Use of this model can support efforts to compare hospitals in resuscitation outcomes as a foundation for quality assessment and improvement. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the practical issues arising in implementation of DNR from the perspectives of maqasid al shari’at and qawa’id al shari’at. Methods: The purposes and principles of the Law provided a conceptual framework for analyzing practical issues related to DNR orders. The issues were identified from a Pubmed literature search with the key word ‘DNR’ covering about 30years and were analyzed as they related to the principles of intention, certainty and preventing harm and also to the purposes of preserving life and resources. Results: It is proposed that DNR orders be written for patients in an established death process, i.e. cardiorespiratory failure beyond Young’s point ‘z’. Patients with terminal incurable conditions who develop acute, reversible cardiorespiratory arrest should be resuscitated if the net benefit will last for a reasonable time. Five components of DNR (cardiopulmonary resuscitation involving chest compression and oxygenation, endotracheal intubation, mechanical ventilation, defibrillation and vasoactive or ionotropic medication) could be provided on a case-by-case basis. The interventions may or may not include renal dialysis, blood transfusion, parenteral nutrition, pulmonary hygiene and normal treatment such as antibiotics. All patients, irrespective of their DNR status, deserve supportive care. Conclusion: To improve DNR processes, training should be given on end-of-life ethical issues for physicians and nurses, DNR orders should specify interventions, the autonomy of physicians who have a conscientious objection to DNR should be respected, more psychosocial support should be given to the families of DNR patients, more empirical research is required on DNR, and DNR decisions should be audited regularly. [Copyright &y& Elsevier]

Background: Infants younger than 1 year old have the highest heart transplant wait-list mortality. Transplantation from donors after circulatory determination of death (DCDD) is an innovative new option for these patients. We examined the potential for heart donation in neonatal intensive care unit (NICU) patients undergoing elective withdrawal of life support. Methods: Medical records of all patients who died between June 2003 and June 2008 in our 84-bed NICU were reviewed. The mode of death among potential organ donors (weight > 2.5 kg) was categorized into 4 groups: Died despite cardiopulmonary resuscitation (CPR), do not resuscitate (DNR) status, brain death, or withdrawal of life support. Patients undergoing planned life-support withdrawal were evaluated for DCDD potential. Results: Of 266 NICU deaths during the study period, 117 patients weighed more than 2.5 kg at the time of death, of whom 15 (13%) died despite CPR, and 33 (28%) were DNR. No brain deaths occurred; consequently, no conventional organ donation resulted. Of 69 infants (59%) who died after withdrawal, 53 were excluded as potential donors due to active infection, cardiac dysfunction, or congenital heart disease. Among the remaining 16, median time from withdrawal to death was 31 minutes (range, < 1–310 minutes). Five infants (4.3% of deaths in babies > 2.5 kg) died within 30 minutes, had good cardiac function, and could have been potential DCDD heart donors. Conclusions: Among NICU patients withdrawn from life support during a 5-year period, 4.3% would have been suitable heart donors after circulatory determination of death. Implementing a NICU DCDD program could markedly expand the donor pool and reduce short-term wait-list mortality for infant heart transplantation. [ABSTRACT FROM AUTHOR]

Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a ‘modernist’ repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a ‘romanticist’ repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply ‘Sanity’ and ‘Stability’ tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families. [ABSTRACT FROM AUTHOR]

I believe the standard for making ethical decisions should be the same for all patients: appropriate medical interventions, carefully weighing their benefits and burdens, and trying to honor the wishes of the patients. When cure is not possible, the balance between benefits and burdens should shift to greater consideration of the burden side of the equation. The ascendancy of autonomy over other medical ethical principles is the center for most of the ethical dilemmas encountered in palliative care. This paper discusses the issues of autonomy, informed consent, patient capacity, advance directives, futility, ‘do-not-resuscitate’ orders, withholding or withdrawing interventions, euthanasia, and sedation therapy. After 41 years of my personally caring for over 4000 terminally ill patients, primarily at Calvary Hospital, the most practical approach has been to establish trust with patients and families, determining their goals, and diligently applying the principles of beneficence (benefits) and nonmaleficence (burdens) in everyday practice. [Copyright &y& Elsevier]

Background and aim. This paper reports on the findings from an ethnographic study involving three wards in two hospitals in the Northwest of England and focuses on the controversial issue of Do Not Resuscitate (DNR) orders. The study aimed to explore the way in which terminal care was provided to older patients and examined the way in which DNR orders were a socially constructed part of the practices of both nurses and doctors. Method. An ethnographic approach was adopted that used participant observation and semi-structured interviews with nurses and doctors. A purposive sample of 28 qualified nurses and five medical staff were interviewed. The decision-making process of DNR orders became the focus of the interview questions. Findings. The findings reveal that DNR decision-making was largely socially constructed from the interactions of hospital staff. Patients were not asked their preference and were excluded from any decision-making about Cardiopulmonary Resuscitation (CPR) or DNR orders. Two major findings emerge. First, DNR orders and the non-use of CPR could be seen as a form of medical beneficence, resulting from the often described paternalistic attitudes of hospital doctors. Second, there was a clear indication that DNR orders and the non-use of CPR for certain patients was based on improving the quality of patients' lives. Conclusion. The study raises issues about the quality of care received by frail older patients whom the nurses felt would not survive a futile medical procedure. The conclusion considers the need for hospitals to formulate and implement CPR policies, particularly in the prevailing climate in which patients are encouraged to become active participants in their own health care. [ABSTRACT FROM AUTHOR]

Objective . The main objective was to discover who had ‘Do Not Resuscitate’ (DNR) status, why, how, when and by whom these decisions were made. Design, setting and patients . The medical and nursing notes of all inpatients (139) (age range 16–100 years) in an inner city district general hospital on a single day were examined to determine the resuscitation status, age, sex and diagnosis of each patient. Result . A decision not to resuscitate had been taken in 28 (20%) of the cases. ‘Do Not Resuscitate’ (DNR) patients were significantly older and more likely to suffer from malignant and cardiorespiratory disease. Patients with dementia and other psychiatric disorders were not significantly more often labelled DNR. Evidence of consultation for these decisions was lacking and the recording erratic. Conclusions . (1) There is a great need to devise and implement comprehensive guidelines. (2) There is need for appropriate and comprehensive documentation outlining the reasons why and how the decision was taken, who was consulted and review date. (3) This is an important area for audit. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors associated with do-not-resuscitate (DNR) status in critically ill patients infected with human immunodeficiency virus (HIV) admitted to the Intensive Care Unit (ICU) in the era of combination antiretroviral therapy (cART)., Materials and Methods: Retrospective cohort study of first-time admissions of HIV-infected patients to ICUs in Edmonton, Alberta, from 2002 to 2014. Multivariable logistic regression analysis was performed to identify factors associated with DNR status., Results: There were 282 HIV-infected patients with first-time ICU admissions, with an incidence rate of 6.6 per 1000 ICU admissions. Sixty-seven (24%) patients had a DNR designation and support was withdrawn in 37 (13%). In multivariable analysis, APACHE II score (OR 1.13; 95% CI, 1.08-1.19, p < 0.001), coronary artery disease (OR 5.70; 95% CI, 1.18-27.76, p = 0.031), prior opportunistic infection (OR 2.59; 95% CI, 1.20-5.57, p = 0.015) and duration of HIV infection (OR 1.07 per year; 95% CI, 1.01-1.14, p = 0.025) were independently associated with DNR status. Ethnicity, HIV risk factors, CD4 count and viral load were not associated with DNR status., Conclusions: One in four patients had a DNR designation. Illness acuity, selected comorbidity, previous opportunistic infection and HIV duration were associated with DNR designation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: chronic and terminal diseases require holistic therapy that covers the biopsychosocial aspect, and it can be found in palliative therapy. Patients who receive palliative therapy exhibit very diverse profiles. As such, researchers are keen to study the general characteristics of palliative patients. In addition, researchers will also assess the patient's and their family's insight that influences the success of the therapy and the impact of estimated survival time in making treatment decisions., Methods: this research used cross-sectional descriptive analytic study and secondary data of 300 palliative patients who consult to Psychosomatic Palliative Team at Dr. Cipto Mangunkusumo Hospital. The data were processed using SPSS version 25. The data processed included: sociodemographic characteristics, length of stay, incidence of death in hospital, DNR cases, the patient's and their family's insight, and the impact of estimated survival time on treatment decisions., Results: most palliative patients were women (52.0%) aged 51 - 60 years (27.0%), unemployed (29.0%), and suffered from cancer (55.3%). In addition, the patients were generally treated for less than 1 month (83.6%), died in the hospital (37.3%), and consented to DNR orders (36.7%). These DNR cases are highly correlated to the family's understanding regarding the prognosis of the patient's condition (p = 0.022). The family's understanding of the diagnosis, prognosis, and treatment goals (92.3%, 81.3%, and 87.7%) was better than the patient's (79.0%, 64.0%, and 69.7%). Furthermore, no link was found between the therapy choice (optimal, withholding, and withdrawing therapies) with the patient's estimated survival time (p = 0.174)., Conclusion: female, elderly, and cancer patients most often get palliative therapy. The consent for DNR orders to palliative patient is notably frequent. Currently, the family's insight is much better than the patient's, which means that health care providers need to improve patient education and information. In addition, patients and families generally still opt for optimal therapy despite low estimated survival time.

End-of-life care (EOLC) care is a unique specialty consisting of comprehensive multidisciplinary healthcare delivery to patients with a wide range of terminal illnesses. However, this form of care raises many ethical questions, and some religions disregard several actions of EOLC. While a complete understanding of all faiths is challenging for a busy healthcare professional, a good grasp of the major religions is essential. In this review paper, we focus on the ethical dilemmas of EOLC in Saudi Arabia from an Islamic perspective, emphasizing the ethics of the right of care. This review helps to demonstrate that the literature on EOLC is global and yet inconclusive in some areas. In Saudi Arabia, there are now more than 15 comprehensive cancer centers with palliative care units. Palliative care is becoming increasingly relevant in the Kingdom as the number of patients diagnosed with severe life-threatening illnesses rises. Despite this, healthcare practitioners' awareness of palliative care remains limited. [SJEMed 2021; 2(3.000): 268-271]

Background: The Renal Physicians Association's clinical practice guideline recommends that physicians address advance care planning with dialysis patients. However, data are lacking about how best to implement this recommendation., Study Design: Quality improvement project., Settings & Participants: Nephrologists caring for patients treated with maintenance hemodialysis at 2 dialysis facilities identified patients who might benefit most from advance care planning using the "surprise" question ("Would I be surprised if this patient died in the next year?")., Quality Improvement Plan: Patients identified with a "no" response to the surprise question were invited to participate in nephrologist-facilitated advance care planning, including completion of a Medical Orders for Life-Sustaining Treatment (MOLST) form., Outcomes: Change in MOLST completion rate and identification of preferences for limits on life-sustaining treatment., Measurements: Pre- and postintervention code status, MOLST completion rate, and vital status at 1 year., Results: Nephrologists answered "no" to the surprise question for 50 of 201 (25%) hemodialysis patients. Of these, 41 (82%) patients had a full-code status and 9 (18%) had a do-not-resuscitate (DNR) status. Encounters lasted 15 to 60 minutes. Following the encounter, 21 (42%) patients expressed preference for a DNR status and 29 (58%) maintained full-code status (P=0.001). The MOLST completion rate increased from 10% to 90%. One-year survival for patients whose nephrologists answered "no" to the surprise question was 58% compared to 92% for those with a "yes" answer (P<0.001)., Limitations: Sample size and possible nonrepresentative dialysis population., Conclusions: Nephrologist-facilitated advance care planning targeting hemodialysis patients with limited life expectancy led to significant changes in documented patient preferences for cardiopulmonary resuscitation and limits on life-sustaining treatment. These changes demonstrate the benefit of advance care planning with dialysis patients and likely reflect better understanding of end-of-life treatment options., (Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Hospice decreases the fear of dying alone, reduces the agony of death, and helps in maintaining dignity at the end of life. Physicians are encouraged to offer hospice to terminally ill patients early on in their end-of-life care to maximize these benefits. However, there is limited data on the changes and characteristics of hospice utilization. We performed a study to determine the changes in the hospice utilization over the last decade in our hospital., Methods: A chart review of all veterans referred to hospice during the years 2001 and 2010 was performed and subsequently analyzed. Analyses were performed with SPSS 19.0 for Windows., Results: Referral to hospice increased significantly but the duration of stay did not change in 2010 in comparison with 2001. Factors associated with increased length of stay were full-code status, receiving hospice at home, hospitalization during enrollment in hospice, referral to hospice by oncologist, and a diagnosis of cancer., Conclusion: Hospice referrals need to be considered earlier in their disease process for terminally ill patients. In addition, requirement of a do-not-resuscitate order as a condition for hospice at some agencies needs to be revisited, and patients should not be discouraged to seek treatment for reversible medical conditions even when enrolled in hospice.

Background: Signed do-not-resuscitate (DNR) consent is the essential first step for terminal cancer patients to choose palliative care and a quality marker of terminal care. DNR consent completeness helps deliver correct information, ensure consent legal validity, reduce medical disputes, and protect patient and family rights. The DNR consent completeness rate during May and June 2005 was only 33.9% in our hospital. Reasons indicated for this low rate included: (1) lack of a standard operating procedure for DNR consent; (2) multiple DNR consent versions; (3) lack of DNR-related education; and (4) lack of monitoring procedures. Our team developed a project to resolve these problems and improve terminal care quality., Purpose: The goal of this project was to increase the rate of DNR consent completeness from 33.9% to 80%., Resolution: The plan, implemented between August and December 2009, included the following components: (1) establish standard guidelines for DNR consent; (2) simplify and unify DNR consent procedures; (3) provide DNR education for hospital staff; and (4) establish a DNR consent monitoring system., Results: The DNR consent completeness rate rose from 33.9% to 90%. The goal of this project was thus achieved., Conclusion: This project effectively improved the DNR consent completeness rate at our hospital. The project ensured patients a good death and enhanced terminal care quality and patient satisfaction. Our experience may provide a reference to help other hospitals increase DNR their consent completeness rates.

Dealing with end-of-life issues in pediatric patients is difficult due to their young age, the complexities of situations leading to illness, and the multiple decision makers that exist in addition to parents and guardians. Pediatric patients do not have living wills addressing specific instructions for how long to continue life support systems such as a ventilator or a G-tube (gastrostomy tube for feeding). The dying pediatric patient also has typically not consented to organ donation either. The burden of decision making lies with the parents, guardians, and health-care providers of the dying child. This paper deals with these complexities and reflects the author's own experiences over nearly four decades of dealing with pediatric patients in her practice.