Dealing with Death Taboo: Discussion of Do-Not-Resuscitate Directives with Chinese patients wtih Noncancer Life-Limiting Illnesses

Abstract Description

Authors (including presenting author) :

Benjamin Hon Wai CHENG 1; Karen Shek 1; Oi-Man CHAN 1; Chun Hung CHAN 2; Ching Wah MAN 1; Carmen Lam 2; KS FUNG 2; WT Wong 2; WK LUI 2; KM LAI 2; PY LAM 2; WT WONG 2; PM MA 2; PL WONG 2; KW CHAN 2; KY WONG 2; YK NG 2

Affiliation :

1 Department of Medicine & Geriatrics, Tuen Mun Hospital 2 Palliative Home Care Nursing Team, NSD, NTWC

Introduction :

Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation (CPR) 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.

Objectives :

We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multi-disciplinary team approach

Methodology :

Retrospective 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-years period.

Result & Outcome :

Over 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 three diagnoses were chronic renal failure (37%), congestive heart failure (16%) and motor neuron disease (11%). 42% 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=0.047] and older (age >75) age group [86.2% vs 66.7%; p=0.012]. Of the 40 deceased patients, median time from signed directives to death was 5 months. Vast majority (95%) had their DNR directives being honored. Conclusion: Healthcare workers should be sensitive towards the cultural influence during advance care planning. Role of family for ethnic Chinese remains crucial and professionals should respect this family-oriented decision-making.