Factors Influencing Family Surrogates’ Intention with Regard to Do-Not-Resuscitate Directive for Patients with Dementia

ABSTRACT

Objective: To investigate the prevalence of family surrogates’ do-not-resuscitate (DNR) intention for patients with dementia (PwD), and factors influencing family surrogates’ decisions.

Methods: This is a descriptive and cross-sectional study. Patients with dementia and their family surrogates from Dementia Outpatient Clinic of a teaching hospital in southern Taiwan were included. Data were collected using chart review and questionnaire survey. Influential factors were analyzed using multiple logistic regression.

Results: One hundred and forty of the 223 participants (62.8%) have intention to sign DNR consents for their dementia relatives. Factors influencing the intention were: (1) Comorbid with musculoskeletal diseases or diabetes (p < .05); (2) psychological symptoms of repetitive wording and behavior (p < .05); (3) spouse (p < .05) and lineal relatives (p < .01); (4) previous discussion between families and patient about DNR directive (p = .001); (5) believers of Taiwan folk belief (Buddhism or Taoism) (p < .05).

Conclusions: Advanced dementia patients cannot express intention about their end-of-life care and depend on family surrogates to decide for them. Our study showed that spouse and direct relatives, comorbidities of musculoskeletal disease or diabetes, psychological symptoms of repetitive wording and behavior, previous discussion about patients’ intention, and believers of Taiwan folk belief are all positive influencing factors for surrogates to consent DNR directive for patients. Our findings are important in promoting DNR directive for PwD.

Clinical implications: Our results may help to promote DNR decisions for dementia patients, especially in Chinese populations.

KEYWORDS:

• Advance health care directive
• dementia
• do-not-resuscitate
• end of life care

Clinical Implications

• A variety of factors are to be considered when promoting DNR advance directive for patients with dementia.

• DNR decision can be made in earlier disease course so that patients with dementia still could communicate better.

Additional information

Funding

This work was supported by National Cheng Kung University Hospital [grant number: NCKUH-10402001].