Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in...
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| Veröffentlicht in: | PloS one 2023-03, Vol.18 (3), p.e0282805-e0282805 |
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| creator | Chuang, Mei-Hsing Hsu, Jiunn-Rong Hung, Chia-Wei Hwang, Yu Long Lee, Chih-Ching Shen, Hsiu-Yi Chang, Fu-Kang Kuo, Li-Lin Chen, Saint Shiou-Sheng Huang, Sheng-Jean |
| description | Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options. |
| doi_str_mv | 10.1371/journal.pone.0282805 |
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Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0282805</identifier><identifier>PMID: 36913360</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Amyotrophic lateral sclerosis ; Amyotrophic Lateral Sclerosis - complications ; Amyotrophic Lateral Sclerosis - therapy ; Analysis ; Cardiopulmonary resuscitation ; Care and treatment ; CPR ; Cross-Sectional Studies ; Death ; Decision making ; Development and progression ; Diabetes ; Diabetes mellitus ; Disease ; Do-not-resuscitate orders ; Dysphagia ; Dyspnea ; End of life ; Engineering and Technology ; Enteral nutrition ; Health aspects ; Hospitalization ; Hospitals ; Humans ; Hypertension ; Male ; Medical diagnosis ; Medical prognosis ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Multivariate analysis ; Nervous system diseases ; Neurodegenerative diseases ; Neurodegenerative Diseases - complications ; Ostomy ; Palliative care ; Palliative treatment ; Patient outcomes ; Patients ; People and Places ; Physical Sciences ; Physicians ; Regression analysis ; Research and Analysis Methods ; Respiratory failure ; Resuscitation Orders ; Retrospective Studies ; Taiwan - epidemiology ; Ventilators</subject><ispartof>PloS one, 2023-03, Vol.18 (3), p.e0282805-e0282805</ispartof><rights>Copyright: © 2023 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Chuang et al 2023 Chuang et al</rights><rights>2023 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c642t-8f7c14534f66e57eabf4e7646824807ebdb53e7474ff0bc9e286e50ce596ca633</cites><orcidid>0000-0001-5412-578X ; 0000-0002-3602-6881</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010504/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010504/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36913360$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chuang, Mei-Hsing</creatorcontrib><creatorcontrib>Hsu, Jiunn-Rong</creatorcontrib><creatorcontrib>Hung, Chia-Wei</creatorcontrib><creatorcontrib>Hwang, Yu Long</creatorcontrib><creatorcontrib>Lee, Chih-Ching</creatorcontrib><creatorcontrib>Shen, Hsiu-Yi</creatorcontrib><creatorcontrib>Chang, Fu-Kang</creatorcontrib><creatorcontrib>Kuo, Li-Lin</creatorcontrib><creatorcontrib>Chen, Saint Shiou-Sheng</creatorcontrib><creatorcontrib>Huang, Sheng-Jean</creatorcontrib><title>Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options.</description><subject>Amyotrophic lateral sclerosis</subject><subject>Amyotrophic Lateral Sclerosis - complications</subject><subject>Amyotrophic Lateral Sclerosis - therapy</subject><subject>Analysis</subject><subject>Cardiopulmonary resuscitation</subject><subject>Care and treatment</subject><subject>CPR</subject><subject>Cross-Sectional Studies</subject><subject>Death</subject><subject>Decision making</subject><subject>Development and progression</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Disease</subject><subject>Do-not-resuscitate orders</subject><subject>Dysphagia</subject><subject>Dyspnea</subject><subject>End of life</subject><subject>Engineering and Technology</subject><subject>Enteral nutrition</subject><subject>Health aspects</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Medicine, Experimental</subject><subject>Multivariate analysis</subject><subject>Nervous system diseases</subject><subject>Neurodegenerative diseases</subject><subject>Neurodegenerative Diseases - complications</subject><subject>Ostomy</subject><subject>Palliative care</subject><subject>Palliative treatment</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Physicians</subject><subject>Regression analysis</subject><subject>Research and Analysis Methods</subject><subject>Respiratory failure</subject><subject>Resuscitation Orders</subject><subject>Retrospective Studies</subject><subject>Taiwan - epidemiology</subject><subject>Ventilators</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11v0zAUhiMEYh_wDxBEQkJwkWLHjp1coWliUGnSJBjcWq5z3LpK42I7jP37ndJsatAukC9sHT_ntc9Xlr2iZEaZpB_Xfgi97mZb38OMlHVZk-pJdkwbVhaiJOzpwfkoO4lxTUjFaiGeZ0dMNJQxQY6z9YU2yYeYa2vBJNcv89YXvU9FgDhE45JOkLdgXHS-R2zjEdnq5KBPMb9xaYW2W5-C366cyTvEg-7yaDoIPrqYuz6_1u5G9y-yZ1Z3EV6O-2n24-Lz9fnX4vLqy_z87LIwgpepqK00lFeMWyGgkqAXloMUXNQlr4mERbuoGEguubVkYRooa-SIgaoRRgvGTrM3e91t56Ma0xRVKWsUEVwKJOZ7ovV6rbbBbXS4VV479dfgw1LpkByGoBhrUJzwCqzmreQNgCG8raXkABQMan0aXxsWG2gNpgXjn4hOb3q3Ukv_W1FCKKkIR4X3o0LwvwaISW1cNNB1ugc_7D9eUUEFQfTtP-jj4Y3UUmMErrdYHW12oupMckpEI6oSqdkjFK4WNs5gU1mH9onDh4kDMgn-pKUeYlTz79_-n736OWXfHbAr0F1aRd8NaddwU5DvQYOdFQPYhyxTonYzcZ8NtZsJNc4Eur0-rNCD0_0QsDtB7whL</recordid><startdate>20230313</startdate><enddate>20230313</enddate><creator>Chuang, Mei-Hsing</creator><creator>Hsu, Jiunn-Rong</creator><creator>Hung, Chia-Wei</creator><creator>Hwang, Yu Long</creator><creator>Lee, Chih-Ching</creator><creator>Shen, Hsiu-Yi</creator><creator>Chang, Fu-Kang</creator><creator>Kuo, Li-Lin</creator><creator>Chen, Saint Shiou-Sheng</creator><creator>Huang, Sheng-Jean</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-5412-578X</orcidid><orcidid>https://orcid.org/0000-0002-3602-6881</orcidid></search><sort><creationdate>20230313</creationdate><title>Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan</title><author>Chuang, Mei-Hsing ; Hsu, Jiunn-Rong ; Hung, Chia-Wei ; Hwang, Yu Long ; Lee, Chih-Ching ; Shen, Hsiu-Yi ; Chang, Fu-Kang ; Kuo, Li-Lin ; Chen, Saint Shiou-Sheng ; Huang, Sheng-Jean</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c642t-8f7c14534f66e57eabf4e7646824807ebdb53e7474ff0bc9e286e50ce596ca633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amyotrophic lateral sclerosis</topic><topic>Amyotrophic Lateral Sclerosis - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chuang, Mei-Hsing</au><au>Hsu, Jiunn-Rong</au><au>Hung, Chia-Wei</au><au>Hwang, Yu Long</au><au>Lee, Chih-Ching</au><au>Shen, Hsiu-Yi</au><au>Chang, Fu-Kang</au><au>Kuo, Li-Lin</au><au>Chen, Saint Shiou-Sheng</au><au>Huang, Sheng-Jean</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-03-13</date><risdate>2023</risdate><volume>18</volume><issue>3</issue><spage>e0282805</spage><epage>e0282805</epage><pages>e0282805-e0282805</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36913360</pmid><doi>10.1371/journal.pone.0282805</doi><tpages>e0282805</tpages><orcidid>https://orcid.org/0000-0001-5412-578X</orcidid><orcidid>https://orcid.org/0000-0002-3602-6881</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-03, Vol.18 (3), p.e0282805-e0282805 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2786466476 |
| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis - complications Amyotrophic Lateral Sclerosis - therapy Analysis Cardiopulmonary resuscitation Care and treatment CPR Cross-Sectional Studies Death Decision making Development and progression Diabetes Diabetes mellitus Disease Do-not-resuscitate orders Dysphagia Dyspnea End of life Engineering and Technology Enteral nutrition Health aspects Hospitalization Hospitals Humans Hypertension Male Medical diagnosis Medical prognosis Medical research Medicine and Health Sciences Medicine, Experimental Multivariate analysis Nervous system diseases Neurodegenerative diseases Neurodegenerative Diseases - complications Ostomy Palliative care Palliative treatment Patient outcomes Patients People and Places Physical Sciences Physicians Regression analysis Research and Analysis Methods Respiratory failure Resuscitation Orders Retrospective Studies Taiwan - epidemiology Ventilators |
| title | Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan |
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