A National Study of Life-Sustaining Treatments in South Korea: What Factors Affect Decision-Making?

Abstract

This cross-sectional study investigated the status of life-sustaining treatment (LST) practices and identified characteristics and factors influencing decision-making practices. Materials and Methods The National Agency for Management of Life-sustaining Treatment retains records provided by doctors regarding patients subject to LST implementation. A total of 71,327 patients receiving LST were identified. We analyzed all nationally reported data between February 2018 and October 2019. Indicators such as the proportion of deaths, records for decision to terminate LST, implementation of LST records, and registration of Advance Statements on LST were analyzed. Results A total of 67,252 (94.3%) end-of life decisions were implemented in South Korea. The proportion of deaths preceded by a LST plan, non-self-determination LST decision, and any advance statements was 33.5% (23,891/71,327), 66.5% (47,436/71,327), and 1.2% (890/71,327), respectively. The logistic regression model revealed that self-determination to terminate LST was more frequent for men than for women and higher for those aged 30-69. Disability (OR: 0.59, 95% CI: 0.56-0.61), living in non-metropolitan areas (OR: 0.84, 95% CI: 0.81-0.86), and disease comorbidity was independently associated with a low level of selfdetermination. Conclusion After the implementation of the new LST Act, about a third of patients in end-of-life process made decisions regarding their medical LST. However, family members still play a major role in LST decisions where the patient's intention cannot be verified. Decisions related to LST are CANCER RESEARCH AND TREATMENT (CRT) 3 Korean Cancer Association This article is protected by copyright. All rights reserved. predominantly made when death is imminent. Thus, it is necessary to increase awareness of end-of-life LST decision making among medical staff and the public.

Preparation and Practice of the Necessary Documents in Hospital for the “Act on Decision of Life-Sustaining Treatment for Patients at the End-of-Life”

“…In the current study, we found that the self-determination rate of LST was 31% and the mean time interval from self-determination to implementation of LST was approximately 8.6 days, which is higher and longer than those from previous studies [1,2,5]. Indeed, the selfdetermination rates from recent single center and national retrospective studies were 29% and 33.5%, respectively [6,7]. There was little difference in the self-determination rate as a result of differences in the hospital settings, enrolled subjects, or research period.…”

Derivation and performance of an end-of-life practice score aimed at interpreting worldwide treatment-limiting decisions in the critically ill

“…Recently reported limitations of clinician-family end-of-life conferences include insufficient information exchange about the patient’s values and preferences and deficient deliberation; this implies that the communication skills of clinicians need to be improved [ 18 , 59 ]. Regarding guidelines per se, these may not effectively address problems of reaching consensus decisions, prognostication challenges, barriers in communication, patient palliative care needs, and physician-related variability in end-of-life decision-making [ 58 – 62 ]. Absence of association or negative associations between a number of the end-of-life practice variables and treatment limitation were noted, and appear to be counter-intuitive and difficult to explain.…”

Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea

“…According to recent studies, around one-third of the patients in Korea made decisions for LST on their own and had a short median time of two days from confirmation of the EOL process to death [ 9 , 10 ]. These results appear to reflect the increased awareness of Korean patient autonomy by taking charge of their own decisions compared to previous findings, which showed that all do-not-resuscitate consents were made between the physician and family without involving the patient before the enforcement of this law [ 11 , 12 ].…”