Difficulties doctors experience during life-sustaining treatment discussion after enactment of the Life-Sustaining Treatment Decisions Act: A cross-sectional study

Abstract

Background In the Republic of Korea, life-sustaining treatment (LST) for patients at the end of life should be legally discussed by a doctor according to the LST Decisions Act, which was enacted in February 2018. However, little is known about challenges doctors experience during LST discussion. This study aims to investigate the perceived difficulties of doctors during LST discussions after enactment of the new Act. Methods A cross-sectional survey was conducted in a tertiary hospital in August 2019 and included 686 doctors (432 attending physicians, 141 clinical fellows, and 295 residents) who care for seriously ill patients. The doctors were given a structured questionnaire, and difficulties during the discussion process were examined. Results A total of 132 doctors answered the questionnaire. Most (86.4%) experienced considerable difficulties during LST discussions (mean score, 7.4 ± 1.6/10). The two most common difficulties were communication with patients and family and determining when to discuss LST. Two-thirds of doctors found direct discussions with the patient difficult and said they would initiate LST discussions only with family. LST discussions were actually initiated later than considered appropriate. When medically assessing whether the patient is imminently dying, 56% of doctors experienced disagreements with other doctors, which could affect their decisions. Conclusion In the present study, most doctors experienced serious difficulties during LST discussions. To alleviate these difficulties, further institutional support is needed.

Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence

“…For various reasons, physicians and parents may have different views about the process and the outcomes of the decision-making. This result from our review was consistent with the results of four quantitative studies that identified a barrier of discrepancies between physicians and parents [80][81][82][83]. In their studies, most paediatricians considered disagreements between physicians and parents about a child's diagnosis and prognosis in the medical assessment to be an important issue in the decision-making process [80][81][82][83].…”

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

“…Presently, the legal transactional mode of advance planning is shifting toward a communication model that accurately translates the patient's wishes [23]. A recent study found that many doctors in SNUH had serious difficulties communicating with patients and family members during LST discussions [24].…”

Association of Perceived Life Satisfaction with Attitudes toward Life-Sustaining Treatment Among the Elderly in South Korea

“…LST is de ned as any treatment that serves to prolong life without reversing the underlying medical condition and includes processes such as mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and arti cial nutrition and hydration [7,8]. The relevant Acts aim to protect the best interests of the patients and respect their self-determinants rights [9]. In countries where well-dying related legislation was implemented earlier, there have been numerous studies and interventions on LST.…”

“…Patients' perceptions of end-of-life care [10,11], as well as related physicians' orders [12,13], and ethical considerations [14,15] were discussed. However, in Korea, not long after the Well-dying Act was enacted, social consensus is still in the process of developing, so there are not many preceding studies examining the perceptions of seriously ill patients and the elderly toward preparation for death or receiving LST [1,9]. Therefore, this study aimed to investigate factors affecting decision making about LST among the Korean elderly and, in particular, examine the association between perceived life satisfaction and attitudes toward LST.…”