Communication for end-of-life care planning among Korean patients with terminal cancer: A context-oriented model

Journal of Pain and Symptom Management

Sim

et al. 2019

Context. To respect a patient's wish for end-of-life care, ''the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life'' was enacted in South Korea in 2016. Current understanding of people who would be involved in advance care planning (ACP) is crucial to disseminate it systematically. Objectives. The objective of this study was to investigate awareness and attitudes toward ACP in South Korea. Methods. A multicenter, nationwide cross-sectional study was conducted a survey regarding ACP among four groups that would have different positions and experiences: 1,001 cancer patients, 1,006 family caregivers, 928 physicians, and 1,005 members of the general public. Results. A total of 16% of the general population, 33% of the patients and caregivers, and 61% of the physicians had knowledge of advance directives. More than 63% of the general population, above 72% of the patients and caregivers, and 97% of the physicians were willing to do so when the disease status was aggravated or terminal. The possibility for changing the plan, uncertainty as to whether directives would actually be followed, and psychological discomfort were common reasons for not wanting to engage in ACP. Routine recommendations for a specific medical condition, heightened accessibility, and health insurance support were common factors that could help facilitate ACP. Conclusion. Our findings suggest that strategies for promoting ACP should reflect different perspectives among the general public, patients, family caregivers, and physicians. Public advocacy, resources for approaching and integrating ACP into routine health care, as well as systematic support provisions are needed.

Section: Main Findings/results Of the Studymentioning

confidence: 99%

Attitudes of the General Public, Cancer Patients, Family Caregivers, and Physicians Toward Advance Care Planning: A Nationwide Survey Before the Enforcement of the Life-Sustaining Treatment Decision-Making Act

Park

Journal of Pain and Symptom Management

Sim

et al. 2019

“…These results seem relevant considering the facts that the terminal state is defined as a life expectancy of 6 months or less in the U.S. Medicare policy [ 8 ] and that the LST Decision Act defines the terminal state as the state in which impending death might occur within a few months. However, in a previous study, concerns about the definition of “terminal state” based on a specific period of life expectancy were raised, and the necessity of taking the whole context into consideration was emphasized [ 9 ]. The American Cancer Society also defined the terminal state more broadly, without referring to life expectancy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives

Koh

et al. 2018

Cancer Res Treat

Self Cite

PurposeThe aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care.Materials and MethodsA survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses.ResultsA total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of “terminal state,” and mostrespondents tried to disclose the patient’s condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion.ConclusionThis study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.

“…These attitudes of older adults were also true at least in some elderly patients in this study; they believed that physicians or family members would make such decisions for them. Diverse perspectives of patients and their family members were supported by a previous study 4) of terminal cancer care experts, which proposed a contextoriented communication algorithm for EOL care discussion based upon the unique context of each patient. Inconsistent and diverse attitudes toward EOL care discussion among elderly patients and family caregivers must be acknowledged, because each individual's value and preference could not or should not be standardized.…”

Section: Discussionmentioning

confidence: 94%

“…Deliverance of bad news along with other barriers is known to make EOL communication difficult to manage. Accordingly, strategies to deal with this private and complex process has been suggested in the form of guidelines 1,2) , protocol 3) , and algorithm 4) . In the EOL care decision-making process, self-determination is believed to be honored, and skepticism about this philosophy is rarely found; this is true in Korea as well.…”

Section: Introductionmentioning

confidence: 99%

Attitudes and Opinions of Elderly Patients and Family Caregivers on End-of-Life Care Discussion

Koh

Park

et al. 2017

Ann Geriatr Med Res

Self Cite

Background: End-of-life (EOL) care decisions have become an urgent issue in Korea in response to recent legislation called the Life-Sustaining Treatment Decision Act of 2016. The present study attempted to explore attitudes and opinions on EOL discussion among elderly patients and their family caregivers since communication regarding EOL care has been argued to be a major premise leading to the best decision making. Methods: The attitudes and opinions of elderly patients and their family caregivers were solicited through focus group interviews. The final sample consisted of 12 patients and 16 family members. Results: Guided by content analysis, 5 themes were revealed. The identified themes were individual approach for delivering bad news and stakeholders involved in the discussion, contradictory attitudes toward advance care planning, mutual understanding, hope for the EOL care discussion process, and resistance to discussion of hospice-palliative care. Conclusion: Study findings suggested that an approach focusing on the individualized needs of patients and family members is required in EOL care discussion for elderly patients.