Preferences for Advance Directives in Korea

Abstract

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea. Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0. Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care. Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

“…30 In accordance with tradition, the eldest son or daughter is obliged by filial piety to do everything to prolong the older person's life, the opinions of family members and health care professionals take precedence over personal opinions or preferences. 31 In terms of preferred place of dying, 10 years ago, Liu and Gu 32 reported that nearly 90% of Chinese decedents older than 80 died at home, whereas our study found that fewer than a quarter (23.1%) wanted to die at home. The increasing number of single households in mainland China and fewer households comprising more than 1 generation means that fewer older people have access to the necessary family caregiver support to be able to die at home.…”

Korean nurses’ perceived facilitators and barriers in provision of end‐of‐life care

“…34,35 Because the concept of advance directives has only been discussed nationwide in recent years, Korean people might not yet be familiar with the concept. 36 Education concerning advance directives for family members and health-care providers is needed for routine EOL care in the future.…”

Facilitators and Barriers to Use of Advance Directives in Korea

“…In 1 study, patients provided reasons for completing an AD, which included the desire to state one's treatment preferences, appoint proxy decision makers in the event that one may be unable to make decisions regarding end-of-life medical treatments, or make decision making by proxies easier; reasons for not completing an AD included lack of or insufficient knowledge of ADs, lack of understanding of the need for ADs, or uncomfortable having end-of-life discussions, including life support. 15 Nonetheless, most communitydwelling Korean people reported a preference for ADs over life-sustaining treatments 7,8 ; in particular, cardiopulmonary resuscitation or intravenous or tube feeding was undesirable in more than 60% of participants when these extended life rather than improved the condition. 7 In the United States, 80% of patients with chronic disease also reported that they were likely to avoid intensive treatments during hospitalization at the end of life.…”

“…15 Nonetheless, most communitydwelling Korean people reported a preference for ADs over life-sustaining treatments 7,8 ; in particular, cardiopulmonary resuscitation or intravenous or tube feeding was undesirable in more than 60% of participants when these extended life rather than improved the condition. 7 In the United States, 80% of patients with chronic disease also reported that they were likely to avoid intensive treatments during hospitalization at the end of life. 28 Health care professionals also reported challenges in decisions regarding end-of-life care and difficulty having such discussions with patients and families and assisting them in easy-to-understand advance care planning.…”

“…5 In addition, more people spend their end-of-life period in hospitals or institutions, and decision making regarding rather aggressive treatments, including life-sustaining treatment, has become an important issue in Korea. [6][7][8] A tradeoff of the prolonged longevity is a substantial burden on individuals with advanced disease, as well as families, health care system, and society, raising a concern about end of life and difficulty in making life-and-death decisions. 2,5,[9][10][11] One strategy that can spare the burden of unnecessary physical, emotional, and financial suffering on individuals and society and stress with regard to decision making at the end of life is the use of advance directives (ADs).…”