An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

Kim, Do Yeun; Lee, Sang Min; Lee, Kyoung Eun; Lee, Hye Ran; Kim, Jee Hyun; Lee, Moon Hyoung; Lee, Jong Seok; Lee, Soon Nam

doi:10.4143/crt.2006.38.4.214

Cited by 17 publications

(9 citation statements)

References 13 publications

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“…Our study found that self-determination rate on LST has increased by up to 29% since the enforcement of the act, which is higherthan those from previous studies [ 3 , 7 , 10 , 11 , 15 ]. In Korea, physicians tend to avoid telling the truth to patients directly, concerned that they might be frightened or depressed, so family caregivers are frequently surrogate decision-makers, and do not always respect the patient’s will [ 11 ].…”

Section: Discussioncontrasting

confidence: 88%

“…Although decision making occurs earlier than before [ 24 , 25 ] given that the interval from advance statement to death was median of 33 days, it does not seem sufficient enough for all the patients to be able to make decision themselves. Additionally, in Korea, DNR orders are usually written in a week before dying [ 7 , 9 , 15 ], which means that most of them are documented without proper ACP. To be more effective, we should consider initiating ACP discussion when a patient is diagnosed with critical or terminal illness [ 17 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients

et al. 2020

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PurposeLife-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. Itremains unclearwhetherthe act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement.Materials and MethodsRetrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn.ResultsOf 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82)withdrewit. We found a higherwithdrawalratewhen family members made the decisions (13.3% vs. 1.7%, p < 0.001).ConclusionAfter the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients

et al. 2020

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“…153 A study from Korea found that the majority of terminal cancer patients received futile intravenous nutrition in the last week of life, with discussions of palliation in only 7% of cases. 154 …”

Section: Worldwide Prevalence Of Overusementioning

confidence: 99%

Evidence for overuse of medical services around the world

et al. 2017

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“…Another important issue is when an LST plan was prepared. According to previous studies, the mean number of days between completion of an advance statement on LST and death is 33 days in South Korea [ 11 , 24 ], whereas the period between completing a DNR order and death was within one week [ 9 , 25 , 26 ]. In other words, patients were making LST-related decisions due to imminent death without necessarily having enough time to deliberate and decide how they want to manage their own death.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

Cited by 17 publications

References 13 publications

Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients

Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients

Evidence for overuse of medical services around the world

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

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