Comparison of End-of-Life Care Intensity between Cancer and Non-cancer Patients: a Single Center Experience

Kim, Jae Min; Baek, Sun Kyung; Kim, Sang Yong; Maeng, Chi Hoon; Han, Jae Joon; Park, Soyoung; Park, Jae Hun

doi:10.14475/kjhpc.2015.18.4.322

Cited by 3 publications

(2 citation statements)

References 21 publications

(5 reference statements)

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“…In addition, cancer patients’ rate of special life-sustaining treatments, such as intensive care unit treatment, ventilator treatment, hemodialysis, and CPR before completion of the consent form for life-sustaining treatment was also lower than that of non-cancer patients. In a domestic study, Kim et al [ 4 ] compared and analyzed the intensity of end-of-life treatment at a single institution, and the degree of special life-sustaining treatment was found to be significantly lower in cancer patients than in non-cancer patients; furthermore, non-cancer patients provided informed consent to withdraw life-sustaining treatment when death was more imminent [ 4 ]. In this study, non-cancer patients had longer intervals from hospitalization to life-sustaining treatment decisions and from the decision to discontinue life-sustaining treatment than cancer patients, but the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience

Jin

Kim

Lee

et al. 2020

Korean J Hosp Palliat Care

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Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld lifesustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold lifesustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop lifesustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P＜0.001). Conclusion: In many cases, the decision to discontinue lifesustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience

Jin

Kim

Lee

et al. 2020

Korean J Hosp Palliat Care

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“…In our study, the number of cancer patients was relatively small in both groups, which led to statistically insignificant results. Compared to cancer patients who have relatively established prognoses (11,13), the estimation of progression or survival from acute deterioration in chronically ill patients without cancer are more difficult. Medical professionals may have difficulty in deciding their end-of-life care (14,15).…”

Section: Decisions On Life-sustaining Treatmentmentioning

confidence: 99%

The impact of the Well-Dying Law in Korea: comparing clinical characteristics and ICU admissions

Lee¹,

Kim²,

Yeo³

et al. 2022

Ann Palliat Med

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Background: Since Korea implemented the Well-Dying Law in 2018, intensive, and end-of-life care have greatly changed. This study sought to determine whether there were any changes in the clinical aspects or appropriateness of intensive care unit admissions before and after the law was implemented. Methods:We performed a single-center retrospective study for 3 months with patients admitted to a medical intensive care unit before and after the law was implemented. We studied a total of 178 patients, divided pre-legislative group (83 patients) and a post-legislative group (95 patients).Results: There were no significant differences in baseline characteristics, including age, sex, educational level, religion, economic status, and the Eastern Cooperative Oncology Group performance scale at the time of admission to the intensive care unit. There were no changes in the proportion of patients with terminal comorbidities, including malignancy and chronic lung diseases, with the exception of a decrease in patients with liver cirrhosis (12.1% in pre vs. 3.2% in post-legislative group, P=0.040). There were no differences in the APACHE II score at the time of admission, or in prognosis, including in-unit mortality (33.7 vs. 33.6%, P=0.53), in-hospital mortality (38.6% vs. 42.1%, P=0.73), and length of stay in the intensive care unit (IQR, 4.0-11.0 vs. 3.0-11.0 days, P=0.493). Last, no differences were observed in the appropriateness of admission, which was assessed by two separate intensivists, before and after implementing the law (P=0.646, and P=0.315, respectively).Conclusions: After the Well-Dying Law was implemented, there was a significant decrease in the number of liver cirrhosis patients admitted to the intensive care unit. No changes in other clinical characteristics, prognosis, and the appropriateness of admission were evident with the implementation of the law.

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End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience

Yoon

Nam

Lee

2018

Korean J Hosp Palliat Care

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End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and twothirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.

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Comparison of End-of-Life Care Intensity between Cancer and Non-cancer Patients: a Single Center Experience

Cited by 3 publications

References 21 publications

End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience

End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience

The impact of the Well-Dying Law in Korea: comparing clinical characteristics and ICU admissions

End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience

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