Risk Management and Healthcare Policy (Dec 2019)

Association Between the Communication Skills of Physicians and the Signing of Do-Not-Resuscitate Consent for Terminally Ill Patients in Emergency Rooms (Cross-Sectional Study)

  • Chen CH,
  • Cheng YH,
  • Chen FJ,
  • Huang EY,
  • Liu PM,
  • Kung CT,
  • Su CH,
  • Chen SH,
  • Chien PC,
  • Hsieh CH

Journal volume & issue
Vol. Volume 12
pp. 307 – 315

Abstract

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Chih-Hung Chen,1,2,* Ya-Hui Cheng,3,4,* Fen-Ju Chen,5 Eng-Yen Huang,6 Po-Ming Liu,7 Chia-Te Kung,8 Chao-Hui Su,3 Shu-Hwa Chen,3,9 Peng-Chen Chien,10 Ching-Hua Hsieh10 1Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; 2Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan; 3Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; 4Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, 736, Taiwan; 5Department of Healthcare Administration, I-Shou University Medical Campus, Kaohsiung 824, Taiwan; 6Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; 7Department of Emergency Medicine, Kaohsiung 802, Taiwan; 8Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; 9School of Nursing, Fooyin University, Kaohsiung 831, Taiwan; 10Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan*These authors contributed equally to this workCorrespondence: Ching-Hua HsiehDepartment of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, TaiwanEmail [email protected]: The signing of do-not-resuscitate (DNR) consent is mandatory in providing a palliative approach in the end-of-life care for the terminally ill patients and requires an effective communication between the physician and the patients or their family members. This study aimed to investigate the association between the communication skills of physicians who participated in the SHARE (supportive environment, how to deliver the bad news, additional information, reassurance, and emotional support) model course on the patient notification and the signing of do-not-resuscitate (DNR) consent by the terminally ill patients at emergency rooms.Methods: Between May 1, 2017 and April 30, 2018, a total of 109 terminally ill patients were enrolled in this study, of which 70 had signed a DNR and 39 had not. Data regarding the patients’ medical records, a questionnaire survey completed by family members, and patient observation forms were used for the assessment of physicians’ communication skills during patient notification. The observation form was designed based on the SHARE model. A multivariate logistic regression model was applied to identify the independent significant factors of the patient and family member variables as well as the four main components of the observation form.Results: The results revealed that knowing how to convey bad news and providing reassurance and emotional support were significantly correlated with a higher rate of signing DNR consent. Additionally, physician-initiated discussion with family members and a predicted limited life expectancy were negative independent significant factors for signing DNR consent.Conclusion: This study revealed that good communication skills help to increase the signing of DNR consent. The learning of such skills from attendance of the SHARE model course is encouraged for the physicians in the palliative care of terminally ill patients in an emergency room.Keywords: communication skills, terminally ill, do-not-resuscitate, DNR, emergency room, ER, SHARE model

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