Determinants of do-not-resuscitate decision in terminally ill patients without cancer receiving palliative care consultation service: A retrospective study.

Palliative care consultation services (PCCS) are currently used to provide care to terminally ill patients in Taiwan. However, research on the determinants of do-not-resuscitate (DNR) decisions among terminally ill patients without cancer in palliative care settings is limited. This study aimed to elucidate the demographic and clinical factors that influence DNR decision-making in terminally ill patients without cancer receiving PCCS. This retrospective study was conducted on terminally ill patients without cancer who consulted the PCCS at a medical center in Taiwan between January 2016 and December 2019. Data from 928 patients were recorded, including details of the DNR decision at the time of receipt of PCCS. Additional variables, such as demographics, disease-related information, symptoms, and psychosocial and spiritual problems, were also evaluated. Logistic regression models were used to estimate odds ratios and corresponding 95% confidence intervals for the predictor variables. Statistical significance was set at P < .05. In total, 928 patients were analyzed, including 845 who had made a DNR decision and 83 who had not. Terminally ill patients without cancer who had not signed a DNR order when receiving PCCS were less likely to experience nausea, vomiting, abdominal fullness, and dying symptoms compared with those who had made a DNR decision. Conversely, patients who had not signed a DNR order exhibited a higher incidence of weakness, infection, incontinence, cough, and dyspnea compared with those who had signed a DNR order. Furthermore, the family members of patients who had not made a DNR decision reported fewer spiritual problems than did the loved ones of patients who had signed a DNR order. These results highlight the factors that can inform and enhance discussions on DNR decisions by addressing the specific needs and concerns of terminally ill patients without cancer and their families. Targeting these factors can improve decision-making processes and overall patient care, ultimately leading to better palliative care outcomes.