Completion rate of Physician Orders for Life-Sustaining Treatment for patients with metastatic or recurrent cancer: A preliminary, cross-sectional study

Abstract

Background: “End of life” is a difficult topic of conversation in East Asian cultures, even among patients and doctors who share a good rapport. In 2016, the Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, which took the form of “Physician Orders for Life-Sustaining Treatment,” was introduced in South Korea. This study was conducted to investigate the completion rate of Physician Orders for Life-Sustaining Treatment in patients with advanced cancer on the active recommendation of physicians, as well as patients’ general attitudes toward end-of-life care. Methods: We conducted a preliminary, cross-sectional descriptive survey on patients with advanced cancer. A total of 101 patients with advanced solid cancer agreed to participate in the study. The primary endpoint was the rate of completion of Physician Orders for Life-Sustaining Treatment based on a doctor’s suggestion. Written interviews were conducted to understand the perceptions and factors influencing patients’ decisions. Results: Of the 101 patients, 72 (71.3%) agreed to prepare Physician Orders for Life-Sustaining Treatment. Patients who had an educational level of high school or higher were more likely to agree to complete Physician Orders for Life-Sustaining Treatment documentation as compared to the lower educational status group. More than half of the respondents who completed Physician Orders for Life-Sustaining Treatment documentation reported that they had more than a fair understanding of “life-sustaining care” or “Physician Orders for Life-Sustaining Treatment.” Participants’ reasons for Physician Orders for Life-Sustaining Treatment completion were diverse. Conclusions: We found that highly educated patients, who understood the concept behind the policy well, tended to accept Physician Orders for Life-Sustaining Treatment without hesitation. Better education, information shared through the media, and conversations with health care providers might improve understanding of Physician Orders for Life-Sustaining Treatment in patients with cancer.

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

“…Studies reported that patients’ beliefs about the benefits of advance care planning were important motivators of their engagement in it; such benefits include the belief that advance care planning promoted autonomy, 25,28,35,37,42,44,56–58 enabled a comfortable end-of-life, 28,37,40,57,58 avoided burdening family members, 25,28,35,37,44,57 and facilitated shared understanding with family members. 37,42,56 Conversely, five groups of patients would be less likely to engage in advance care planning: (a) those who believed that it was not beneficial 43,56 ; (b) those who believed that engaging in it might cause conflict between their family members or distress to them 41,42,44,48,50,55,58 or to themselves 29,30,33,41,42,55 ; (c) those who believed that discussing death would bring bad luck 30,50,58 ; (d) those who believed that signing the advance care planning document would lead to substandard care 30 ; and (e) those who were not sure that it would guarantee their wishes were respected.…”

“…Ultimately, 36 were included (Figure 2), 22 of which had used quantitative methods, 10 of which had used qualitative methods, and 4 of which had used mixed methods (Table 1 and Supplemental Appendix 2). A majority of the studies (N = 25) had been conducted in high-income countries 22 : Japan, [23][24][25][26] South Korea, 24,[27][28][29][30][31][32][33][34][35] Hong Kong, [36][37][38][39][40][41] Singapore, [42][43][44] and Taiwan. [45][46][47][48][49][50] The term advance care planning was used in 15 studies, most of which had been published in the last decade.…”

“…54 Ten studies reported that 32%-88% of Asian patients were willing to draft an advance directive: Hong Kong (88% of nursing home residents, 49% of critically-ill elderly patients, and 34% of cancer patients) [37][38][39] ; China (32% of nursing home residents and 80% of cancer patients) 53,56 ; and South Korea (52%-74% of advanced cancer patients; 59% of nursing home residents). 27,28,30,33,35 Patient's perspectives on the decision maker in advance care planning. Seven quantitative studies reported the perspectives of Asian patients on their own role, and the roles of their family and physicians, regarding decisionmaking in advance care planning (Supplemental Appendix 6).…”

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

“…A previous study on intensive care unit doctors in Asia reported that among the factors that these doctors considered to be important in making LSTrelated decisions, the needs of the family accounted for 77.9%; it was only surpassed by the factors patient's intention (84.1%) and long-term quality of life [3]. It is well-established fact that the physician's perception of the intention of the family and the preference of the patient may sometimes be different than the patient's original intention [1,20,21]. Personal characteristics or experience of the physician could also influence LST-related decisions, which inherently presents the risk of a decision being made contrary to the patient's intention [11].…”

“…Considering that one in three US adults files any type of advance statement on LST [17], longterm policies for increasing the completion rate of advance statement on LST among adults aged ≥19 years are needed in Asia, including South Korea [20][21][22][23].…”