The associations between the religious background, social supports, and do-not-resuscitate orders in Taiwan: An observational study

Abstract

Prior studies have demonstrated important implications related to religiosity and a do-not-resuscitate (DNR) decision. However, the association between patients' religious background and DNR decisions is vague. In particular, the association between the religious background of Buddhism/Daoism and DNR decisions has never been examined. The objective of this study was to examine the association between patients' religious background and their DNR decisions, with a particular focus on Buddhism/Daoism. The medical records of the patients who were admitted to the 3 surgical intensive care units (SICU) in a university-Affiliated medical center located at Northern Taiwan from June 1, 2011 to December 31, 2013 were retrospectively collected. We compared the clinical/demographic variables of DNR patients with those of non-DNR patients using the Student t test or x2 test depending on the scale of the variables. We used multivariate logistic regression analysis to examine the association between the religious backgrounds and DNR decisions. A sample of 1909 patients was collected: 122 patients had a DNR order; and 1787 patients did not have a DNR order. Old age (P=0.02), unemployment (P=0.02), admission diagnosis of "nonoperative, cardiac failure/insufficiency" (P=0.03), and severe acute illness at SICU admission (P<0.01) were significantly associated with signing of DNR orders. Patients' religious background of Buddhism/Daoism (P=0.04), married marital status (P=0.02), and admission diagnosis of "postoperative, major surgery" (P=0.02) were less likely to have a DNR order written during their SICU stay. Furthermore, patients with poor social support, as indicated by marital and working status, were more likely to consent to a DNR order during SICU stay. This study showed that the religious background of Buddhism/ Daoism was significantly associated with a lower likelihood of consenting to a DNR, and poor social support was significantly associated with a higher likelihood of having a DNR order written during SICU stay.