Understanding of the Do-Not-Resuscitate (DNR) order varies among different ethnic backgrounds. In Korea, the concept of DNR is not well-known. We therefore conducted a questionnaire-based study to explore and characterize ethnic differences (Korean vs. Non-Korean) in the understanding of DNR.
Subjects were recruited from the Englewood Hospital and Medical Center where is a large Korean patient population. The Korean questionnaires were provided to Korean patients. All other patients were provided with English questionnaires. Investigators assisted and answered inquiries at bedside when patients filled out questionnaires. One Korean-speaking investigator gathered the data from Korean population. The inclusion criteria were age over 50, ability of patient to complete the questionnaire, and consent. The exclusion criteria were cognitive impairment including dementia and delirium, and refusal to participate.
21 non-Korean and 17 Korean patients completed questionnaires. Among two populations, there was no significant difference in terms of sex (male: 61.9% vs.76.5%, p=0.9225) and mean age (75.33 vs. 71.29, p=0.2573). The most common ethnic background in the non-Korean population was Caucasian (57.14%). The major religion was Christian/Catholic in both groups (80.95% vs.70.59%, p=0.4549). In the Korean population, fewer patients had heard the term DNR compared to non-Korean patients (66.67% vs. 11.76%, p<0.001). Fewer Korean patients had discussions regarding their End-of-Life care with physicians or family than non-Korean patients, though these differences did not reach statistical significance (28.57% vs 5.88%, p=0.0728; 52.38% vs. 35.29%, p=0.2922). More non-Korean patients had Advance Directives or Power of Attorney for Health Care compared to Korean patients (71.43% vs. 5.88%, p<0.001; 66.67% vs. 17.65%, p<0.01).
We demonstrated that fewer Korean patients had heard of DNR orders, and discussed their End-of-Life care with physicians or family compared to the non-Korean population. Health care professionals should consider ethnic differences when they discuss End-of-Life care issues including DNR orders.