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The effect of joint involvement of nurse and physician in hospice care on terminal cancer patients on do-not-resuscitate orders signed by surrogates

Published online by Cambridge University Press:  27 June 2022

Ling-Hui Huang
Taichung Veterans General Hospital, Taichung, Taiwan
Chia-Hui Chang
Taichung Veterans General Hospital, Taichung, Taiwan
Chien-Lun Chu
Cancer Registry and Screening, Cancer Center, China Medical University Hospital, Taichung, Taiwan
Tung-Han Tsai
Department of Health Services Administration, China Medical University, Taichung, Taiwan
Chiu-Ming Yang
Department of Health Services Administration, China Medical University, Taichung, Taiwan
Shwn-Huey Shieh*
Department of Health Services Administration, China Medical University, Taichung, Taiwan Department of Nursing, China Medical University Hospital, Taichung, Taiwan Department of Nursing, Asia University, Taichung, Taiwan
Author for correspondence: Shwn-Huey Shieh, Department of Health Services Administration, China Medical University, 100, Sec. 1, Jingmao Road, Taichung 406040, Taiwan. E-mail:



Patients with terminal cancer often experience physical and mental distress. Signing a do-not-resuscitate order (DNR) is crucial to protect against invalid treatment. This study aims to explore the effect of hospice shared care intervention by medical staff on the completion of a DNR-S (DNR order signed by surrogates) for patients with terminal cancer.


The cross-sectional study in this research involved secondary analysis of data from the 2011–2015 clinical cancer case management database of a medical center in central Taiwan. Those with a DNR order signed by patients (DNR-P) or DNR-S before the hospice shared care consultation were excluded from this study; a total of 1,306 patients with terminal cancer were selected.


This study demonstrated that the percentage of DNR-S after consultation involving both nurse and physician was 75.4%. With other variables controlled, the number of DNR-Ss after consultation with a nurse was significantly lower [odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.42–0.75] and that of DNR-Ss after consultation involving both nurse and physician was significantly higher (OR = 1.35, 95% CI = 1.01–1.79), than that of DNR-Ss after consultation with only the physician.

Significance of results

Joint involvement of the nurse and physician in hospice care provides sufficient information to patients and family with terminal cancer about their condition and enhances doctor–patient communication. This effectively assists patients with terminal cancer and their family members in making the major decision of signing a DNR, alleviates the concerns of patients and family members about signing a DNR, and reduces terminal cancer patients’ pain at the end of life to ensure that they die in peace and dignity.

Original Article
Copyright © The Author(s), 2022. Published by Cambridge University Press

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These authors contributed equally to this work.



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