Do-Not-Resuscitate Orders at a Teaching Hospital in Japan
New England Journal of Medicine. 1995 Sep 21; 333(12): 805-808.
The use of cardiopulmonary resuscitation (CPR) must be considered carefully, especially in the case of terminally ill and elderly patients. In Japan, most physicians (96 percent) are aware of do-not-resuscitate (DNR) orders, but unlike the situation in other countries, there has been comparatively little discussion here of DNR policy. There also seems to be inadequate use of DNR orders. We found, for example, that futile CPR is often performed at the time of death in patients with terminal lung cancer. We suspect that the reasons for the futile efforts at resuscitation include the lack of a uniform policy regarding DNR orders and poor communication of DNR orders among members of the medical staff. Having a DNR policy at an institution increases the number of patients for whom these orders are written near the time of death and reduces the frequency of resuscitative efforts in terminally ill patients. Therefore, we developed guidelines for DNR orders and an order form that we believed would improve the documentation of the orders. To study the effect of using the policy and order form, we analyzed patients' deaths and the manner in which DNR orders were implemented at a Japanese teaching hospital.
Cancer; Communication; Death; Decision Making; Disclosure; DNR Orders; Evaluation; Evaluation Studies; Family Members; Guidelines; Hospitals; Institutional Policies; Life; Morbidity; Patients; Physicians; Prognosis; Public Opinion; Quality of Life; Records; Resuscitation; Resuscitation Orders; Survey; Terminally Ill;
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