An empirical analysis of the decision-making of limiting life-sustaining treatment for patients with advanced chronic obstructive pulmonary disease in Hong Kong, China☆
Section snippets
Multiple-case studies design
The study design is based on Yin’s case study method.17 It is a research strategy that involves carrying out an empirical inquiry using multiple sources of evidence to examine and represent individual experiences and group interaction within their social context. Triangulation of different data sources was employed to examine DNI practices in the medical departments of 2 hospitals. These hospitals belong to the same cluster under the Hospital Authority of Hong Kong. One is a comprehensive acute
Prognostic factors surrounding DNI decision-making
Of the 49 records under review, as outlined in Table 1, the patients’ average length of survival from the day of DNI decision to the day of death was 210 days (SD: 353.5, range: 1–1450 days). Eleven (22.5%) died within 1 week after the DNI decision was made, and 11 (22.5%) survived more than 1 year after the DNI decision was made. Three major DNI decision-making patterns were delineated. They are 1) Patient-initiated, and shared DNI decision-making with physician (P-S-D, n = 14); 2)
Discussions
Figure 1 summarizes the prognostic and quality-of-life considerations in DNI decision-making. The empirical analysis shows that three DNI decision-making patterns coexist in the practice context. Both P-S-D and D-S-P/F patterns have the patients actively engaged in the decision-making process. DNI decision-making is characterized by a consensus building process in which the patients, their families and healthcare providers come to a state of prognostic awareness that it is for the best
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This work was supported by the Research Grants Council of the Hong Kong Special Administrative Region, China (PolyU7257/00H)