Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Statement
2.2. Setting and Participants
2.3. Measures
2.4. Statistical Analysis
3. Results
3.1. Characteristics of Participants
3.2. Participants’ Experiences and Attitudes Regarding Discussions of DNR and LST Withdrawal
3.3. Factors Related to Attitudes toward Discussions of Do-Not-Resuscitate (DNR) Decisions for Terminally Ill Patients in the Future
3.4. Factors Related to Attitudes toward Discussions of Life-Sustaining Treatment (LST) Withdrawal for Terminally Ill Patients in the Future
3.5. Open-Ended Questions for Mechanical Ventilation Withdrawal Discussions
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Component 1. Past Experiences of DNR and Withdrawal of LST Discussions |
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Component 2. Attitudes to Discussing DNR and Withdrawal of LST in the Future Care of Terminally Ill Patients |
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Component 3. Other Open-Ended Questions |
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Component 4. Demographic Information |
|
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Characteristics | n | % |
---|---|---|
Sex | ||
Female | 116 | 87.9 |
Education level | ||
University | 113 | 85.6 |
Above university | 19 | 14.4 |
Marital status | ||
Single | 75 | 56.8 |
Married | 57 | 43.2 |
Religious belief | ||
None | 47 | 35.6 |
Buddhism | 39 | 29.5 |
Taoism | 21 | 15.9 |
General folk belief | 20 | 15.2 |
Christian | 4 | 3.0 |
Others | 1 | 0.8 |
Items | No | Yes | p Value | Missing | |||
---|---|---|---|---|---|---|---|
no. | % | no. | % | no. | % | ||
Had you ever actively initiated DNR discussions with patients? | 48 | 38.1 | 78 | 61.9 | <0.0001 | 2 | 1.6 |
Had you ever actively initiated DNR discussions with patients’ families? | 35 | 27.8 | 91 | 72.2 | 2 | 1.6 | |
Had you ever actively initiated discussions on withdrawal of LST with patients? | 97 | 78.2 | 27 | 21.8 | <0.0001 | 4 | 3.1 |
Had you ever actively initiated discussions on withdrawal of LST with patients’ families? | 75 | 60.5 | 49 | 39.5 | 4 | 3.1 | |
Will you discuss DNR decisions with patients when taking care of terminally ill patients in the future? | 34 | 27.6 | 89 | 62.4 | <0.0001 | 5 | 3.9 |
Will you discuss DNR decisions with patients’ families when taking care of terminally ill patients in the future? | 24 | 19.5 | 99 | 80.5 | 5 | 3.9 | |
Will you discuss withdrawal of LST decisions with patients when taking care of terminally ill patients in the future? | 62 | 51.7 | 58 | 48.3 | <0.0001 | 8 | 6.3 |
Will you discuss withdrawal of LST decisions with patients’ families when taking care of terminally ill patients in the future? | 54 | 45.0 | 66 | 55.0 | 8 | 6.3 |
Variable | Discuss with Patients | Discuss with Patients’ Families | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | |
Experiences of actively initiating DNR discussions with patients | ||||||
No | Reference | Reference | ||||
Yes | 3.25 | 1.01–10.50 | 0.048 | 2.62 | 0.64–10.61 | 0.180 |
Experiences of actively initiating DNR discussions with patients’ families | ||||||
No | Reference | Reference | ||||
Yes | 5.45 | 1.65–17.96 | 0.005 | 5.03 | 1.31–19.34 | 0.019 |
Experiences of actively initiating discussions on life-sustaining treatment withdrawal with patients | ||||||
No | Reference | Reference | ||||
Yes | 0.99 | 0.14–6.92 | 0.99 | 0.76 | 0.05–10.98 | 0.842 |
Experiences of actively initiating discussions on life-sustaining treatment withdrawal with patients’ families | ||||||
No | Reference | Reference | ||||
Yes | 2.44 | 0.64–9.37 | 0.193 | 7.13 | 1.12–45.54 | 0.038 |
Age (Year) | ||||||
20.0~29.9 | Reference | Reference | ||||
30.0~39.9 | 0.29 | 0.06–1.41 | 0.126 | 0.24 | 0.04–1.52 | 0.130 |
40.0~60.0 | 0.08 | 0.01–0.55 | 0.01 | 0.06 | 0.01–0.49 | 0.009 |
Sex | ||||||
Female | Reference | Reference | ||||
Male | 3.07 | 0.32–29.74 | 0.333 | 0.68 | 0.07–6.93 | 0.742 |
Marital status | ||||||
Married | Reference | Reference | ||||
Single | 0.61 | 0.18–2.11 | 0.433 | 0.71 | 0.18–2.80 | 0.626 |
Education level | ||||||
University | Reference | Reference | ||||
Above university | 6.88 | 0.99–48.10 | 0.052 | 5.16 | 0.51–51.93 | 0.163 |
Religious belief | ||||||
No | Reference | Reference | ||||
Yes | 0.87 | 0.27–2.78 | 0.818 | 1.19 | 0.34–4.19 | 0.791 |
Cox & Snell R-square | 0.316 | 0.289 |
Variable | Discuss with Patients | Discuss with Patients’ Families | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | |
Experiences of actively initiating do-not-resuscitate discussions with patients | ||||||
No | Reference | Reference | ||||
Yes | 0.80 | 0.27–2.41 | 0.692 | 0.88 | 0.29–2.71 | 0.824 |
Experiences of actively initiating do-not-resuscitate discussions with patients’ families | ||||||
No | Reference | Reference | ||||
Yes | 1.98 | 0.62–6.36 | 0.250 | 1.60 | 0.50–5.17 | 0.433 |
Experiences of actively initiating discussions on LST withdrawal with patients | ||||||
No | Reference | Reference | ||||
Yes | 0.89 | 0.22–3.65 | 0.876 | 0.52 | 0.10–2.58 | 0.422 |
Experiences of actively initiating discussions on LST withdrawal with patients’ families | ||||||
No | Reference | Reference | ||||
Yes | 5.55 | 1.60–19.26 | 0.007 | 13.52 | 3.25–56.23 | <0.0001 |
Age (Year) | ||||||
20.0~29.9 | Reference | Reference | ||||
30.0~39.9 | 1.31 | 0.38–4.55 | 0.672 | 1.59 | 0.43–5.80 | 0.486 |
40.0~60.0 | 0.19 | 0.03–1.06 | 0.058 | 0.29 | 0.05–1.64 | 0.161 |
Sex | ||||||
Female | Reference | Reference | ||||
Male | 25.50 | 2.68–243.01 | 0.005 | 25.65 | 2.64–249.42 | 0.005 |
Marital status | ||||||
Married | Reference | Reference | ||||
Single | 0.42 | 0.13–1.41 | 0.144 | 0.44 | 0.13–1.47 | 0.183 |
Education level | ||||||
University | Reference | Reference | ||||
Above university | 29.48 | 4.19–207.32 | 0.001 | 39.84 | 3.58–443.66 | 0.003 |
Religious belief | ||||||
No | Reference | Reference | ||||
Yes | 1.96 | 0.70–5.47 | 0.199 | 2.14 | 0.73–6.25 | 0.164 |
Cox & Snell R-square | 0.340 | 0.370 |
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Share and Cite
Chang, H.-T.; Lin, M.-H.; Chen, C.-K.; Chen, T.-J.; Hwang, S.-J. Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study. Int. J. Environ. Res. Public Health 2020, 17, 557. https://doi.org/10.3390/ijerph17020557
Chang H-T, Lin M-H, Chen C-K, Chen T-J, Hwang S-J. Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2020; 17(2):557. https://doi.org/10.3390/ijerph17020557
Chicago/Turabian StyleChang, Hsiao-Ting, Ming-Hwai Lin, Chun-Ku Chen, Tzeng-Ji Chen, and Shinn-Jang Hwang. 2020. "Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study" International Journal of Environmental Research and Public Health 17, no. 2: 557. https://doi.org/10.3390/ijerph17020557