End-of-life care decisions using a Korean advance directive among cancer patient–caregiver dyads

Kim, Shinmi; Koh, Su‐Jin; Park, Kwonoh; Kim, Jinshil

doi:10.1017/s1478951516000808

Cited by 20 publications

(52 citation statements)

References 24 publications

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“…Patients had difficulty in understanding the POLST, such as concept, the process, and advantages and disadvantages. Emotional discomfort for discussing the POLST was also an important barrier, which was also consistent with previous reports [21,23,25]. Patients showed fear of being abandoned by their physicians and fear of losing hope or experiencing unfavorable events if they sign the POLST form.…”

Section: Discussionsupporting

confidence: 87%

A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer.

Koh

Jun

et al. 2018

JCO

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8 Background: Terminally ill patients can decide end-of-life preferences with physicians in Physician Orders for Life-Sustaining Treatment (POLST) form. We did multi-center, prospective study to assess the feasibility of completing the POLST form in real oncologic practice. Methods: The inclusion criteria were patients with terminal cancer, age ≥20, and sufficient to communicate. The primary end point was the completion rate of the POLST. The questionnaire about the barriers from physicians or patients was asked to whom refused the POLST discussion. Results: From June to December 2017, 336 patients were enrolled from seven hospitals. The median age was 66 (20–94) years, 52.7% were male, 60.4% showed ECOG 3/4, and hepato-pancreato-biliary (26.2%) was the most common origin, followed by lung (23.2%) and gastro-intestinal (19.9%). Patients were in various situations: hospice care (41.2%), after progression (37.9%), under active treatment (15.8%), or just diagnosed as cancer (5.1%). The expected survival duration was 10.6 ±7.3 months. The POLST forms were introduced in 60.1%, and 31.3% signed the form. The barriers from physicians were reluctance of family members (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%); lack of time (22.7%), guilty feeling (21.5%), prognostic (21.0%) or time (16.6%) uncertainty. The barriers from patients were lack of knowledge/understanding in 41.3% for each, denial of prognosis (14.3%), emotional discomfort (63.5%), and difficulty in making decision by themselves (66.7%). Conclusions: One-third of patients completed the POLST forms, and various barriers were found. To overcome those barriers, social engagement, education, and systemic support might be necessary.

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Section: Discussionsupporting

confidence: 87%

A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer.

Koh

Jun

et al. 2018

JCO

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“…A part of the K‐AD model, which consists of a value statement, treatment directives and proxy, was used to assess AD treatments. The K‐AD model, which is a culturally acceptable, reality‐based, user‐friendly form of an AD developed through a series of research studies, has been administered to explore the ADs of Korean adults with cancer and non‐cancer diseases in both clinical and non‐clinical settings (J. Kim, M. An, S. W. Hong, S. Heo, H. Kim, A. Jung, & J. Shim, unpublished data; Kim, Koh, Park, & Kim, ). In this study, treatment directives, which specify one's preferred EoL treatments, were revised by the researchers accordingly after the enforcement of the LST Act (The National Law Information Center, ).…”

Section: Methodsmentioning

confidence: 99%

Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

Kim

Heo

Hong

et al. 2019

Int J Older People Nursing

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Background: Concerns over the creation of advance directives (ADs) and the factors associated with treatment directive decisions among Korean community-dwelling older people with chronic diseases have rarely been addressed. Objectives:This study aimed to examine knowledge, attitudes and barriers/benefits regarding ADs and their associations with AD treatment preferences among chronically ill, low-income, community-dwelling older people.Methods: Using a descriptive, correlational design, older people who were recipients of home visiting service for chronic disease management participated in this study.Home visiting nurses collected data on knowledge, attitudes and perceived barriers/ benefits and treatment directives using questionnaires during home visits. Results:Older people (N = 112, mean age = 74.9 years, women = 83.9%) who had chronic diseases such as hypertension (56.3%), diabetes mellitus (40.2%) and cardiovascular disease/stroke (22.3%) participated. Approximately half of the participants preferred hospice care (54.5%), while a few of them preferred aggressive treatments: cardiopulmonary resuscitation (CPR) (14.3%), ventilation support (9.8%) and haemodialysis (8.9%). Being married was associated with the likelihood of preferring CPR (odds ratio [OR] = 11.79) and ventilation support (OR = 9.99), higher education with CPR (OR = 1.23) and haemodialysis (OR = 1.16), and having a cardiovascular disease (CVD)/stroke with CPR (OR = 6.46) and hospice care (OR = 3.06). Among the modifiable factors, greater perceived barriers increased the likelihood of CPR preference (OR = 1.12) but decreased the likelihood of hospice care preference (OR = 0.96).Greater perceived benefits decreased the likelihood of CPR preference (OR = 0.81) and ventilation support (OR = 0.89), and AD knowledge decreased the likelihood of haemodialysis preference (OR = 0.23). Conclusion:The multidimensional factors were differently associated with each of the AD treatment preferences. Modifiable factors, including perceived barriers and benefits and knowledge, should be improved to help low-income, community-dwelling older people select adequate AD treatment preferences.Implications for practice: Additional information regarding AD treatments and some modifiable and non-modifiable correlates can be integrated into primary and palliative/supportive care in public health. The current home visitation service may also

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“…Further, a larger study is warranted to assess the demographic and clinical characteristics of patients to increase the awareness and documentation of ADs in Korea. The specific responses to each component of the K-AD model in the patients with HF were similar to those of other Korean populations with and without cancer [23,33], particularly those of community-dwelling elderly individuals [23]. Comfortable death (31.8%) and reluctance to burden the family with their care (13.6%) were highly valued among the patients with HF.…”

Section: Discussionmentioning

confidence: 53%

“…Further, the patients of young-er age, lower educational status, female sex, without spouse, and having more severe HF preferred to receive both an aggressive treatment and hospice care in contrast to those with no choices or either EOL treatments or hospice care in this study. In other studies in Korea, CPR was less preferred by patients with cancer-caregiver dyads (20.5% vs. 27.3%) and artificial ventilation (20.5% vs. 36.4%) [33]. In community-dwelling elderly individuals, CPR (23.3%) and artificial ventilation (24.0%) were similarly selected [23].…”

Section: Discussionmentioning

confidence: 82%

“…Also, comfortable death (57.9%) and no burden to the family (24.3%) were valued by healthy adults. Most patients with cancer (73.8%) and their caregivers (66.7%) valued comfortable death more, primarily with no pain and/or no burden to the family [33]. Regarding the EOL futile LSTs, approximately one in three patients with HF (31.8%) showed preference for CPR, and only two patients showed preference for artificial ventilation or hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

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Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

Kim

Heo

et al. 2020

Korean J Intern Med

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Background/Aims: Advance directives (ADs) in Korean patients with heart failure (HF) and the associations of attitude towards ADs and HF prognosis with ADs were initially assessed using the model of the Korean-Advance Directive (K-AD). Methods: Twenty-four patients with HF (age, 67.1 years; men, 58.3%; ejection fraction, 35.9%) participated. A pilot test to evaluate the feasibility of ADs and the possible associations of attitudes towards ADs and prognosis with end-of-life treatment preferences among patients with HF was conducted. Results: Fifteen patients (62.5%) completed the K-ADs. The major reason for incomplete K-AD was knowledge deficit. Patients valued "comfortable death" the most (45.4%), followed by "giving no burden to the family" (13.6%). Among treatment preferences, hospice care was preferred by the majority (66.7%), while cardiopulmonary resuscitation (CPR) was preferred by the minority (31.8%). Children (50.0%) were mostly appointed as a proxy, followed by the spouse (33.3%). More patients with moderately positive attitudes completed the K-ADs than their counterparts (70.0% vs. 57.1%). The 5-year survival rate was 69.2%; the patients who preferred CPR had a higher survival rate (70.6% vs. 68.5%) whereas those who preferred hospice care had a lower survival rate than their counterparts (70.7% vs. 75.2%). Conclusions: The findings support the feasibility of the K-AD model, with a high acceptance rate in two-thirds of the sample. Further studies are warranted to investigate whether treatment preferences are associated with attitude towards ADs and/or HF prognosis using larger sample size.

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End-of-life care decisions using a Korean advance directive among cancer patient–caregiver dyads

Abstract: The degree of patient-caregiver concordance on the K-AD seemed applicable, and achieved mild to moderate concordance. Our findings are exploratory but suggest the need for EoL discussions where patient-caregiver dyads are encouraged to participate in EoL care decision making.

Cited by 20 publications

References 24 publications

A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer.

A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer.

Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

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