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)

Chih-Hung Chen; Ya-Hui Cheng; Fen-Ju Chen; Eng-Yen Huang; Po-Ming Liu; Chia-Te Kung; Chao-Hui Su; Shu-Hwa Chen; Peng-Chen Chien; Ching-Hua Hsieh

doi:10.2147/RMHP.S232983

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)

Risk Manag Healthc Policy. 2019 Dec 11:12:307-315. doi: 10.2147/RMHP.S232983. eCollection 2019.

Authors

Chih-Hung Chen^#^{1

2}, Ya-Hui Cheng^#^{3

4}, Fen-Ju Chen⁵, Eng-Yen Huang⁶, Po-Ming Liu⁷, Chia-Te Kung⁸, Chao-Hui Su³, Shu-Hwa Chen^{3

9}, Peng-Chen Chien¹⁰, Ching-Hua Hsieh¹⁰

Affiliations

¹ Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
² Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan.
³ Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
⁴ Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, 736, Taiwan.
⁵ Department of Healthcare Administration, I-Shou University Medical Campus, Kaohsiung 824, Taiwan.
⁶ Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
⁷ Department of Emergency Medicine, Kaohsiung 802, Taiwan.
⁸ Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
⁹ School of Nursing, Fooyin University, Kaohsiung 831, Taiwan.
¹⁰ Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.

^# Contributed equally.

Abstract

Background: 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: DNR; ER; SHARE model; communication skills; do-not-resuscitate; emergency room; terminally ill.