Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Life-Sustaining Treatment in End-Stage Liver Disease Patients: Patients' Decisions and Results

  • Received : 2020.02.22
  • Accepted : 2020.04.29
  • Published : 2020.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with end-stage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

Keywords

References

  1. Ostgathe C, Alt-Epping B, Golla H, Gaertner J, Lindena G, Radbruch L, et al. Non-cancer patients in specialized palliative care in Germany: what are the problems? Palliat Med 2011;25:148-52.
  2. Nam EJ, Lee SN, Lee R. Comparison of life-sustaining treatment in terminal cancer patients between a cancer and hospice unit after do-notresuscitate orders. Asian Oncol Nurs 2018;18:198-205. https://doi.org/10.5388/aon.2018.18.4.198
  3. Ryu GH. Consideration on the Life-Sustaining Treatment Decision System. Legal Theory Prac Rev 2019;7:191-211.
  4. Kim MY. Hospice and palliative care in end stage liver disease. Korean J Hosp Palliat Care 2017;20:167-72.
  5. Lim JW, Kim SY, Ke SS, Cho BL. The association chronic liver diseases with health related behaviors in South Korea. Korean J Fam Med 2010;31:302-07. https://doi.org/10.4082/kjfm.2010.31.4.302
  6. Shin JY, Yoon SJ, Kim SH, Lee ES, Koh SJ, Park JO. A qualitative study of physicians' perspectives on non-cancer hospice-palliative care in Korea: Focus on AIDS, COPD and Liver Cirrhosis. Korean J Hosp Palliat Care 2017;20:177-87.
  7. Yun SY, Kang JY. Preferences for care near the end of life according to chronic patients' characteristics. J Korean Acad Adult Nurs 2013;25:207-18.
  8. Yoo SY. Liver transplantation in the last 7 years: National Health Insurance Database Study. Sci Rep 2015;9:78-86. https://doi.org/10.1038/s41598-018-36984-y
  9. Lee MA. Withdrawal of life-prolonging medical care and hospice-palliative care. J Korean Med Assoc 2019;62:369-75.
  10. MOHW: Announcement [Internet]. Sejong: Ministry of Health and Welfare; 2019 [cited 2019 Feb 14]. Available from: https://www.mohw.go.kr.
  11. Kang NY, Park JY. Clinical characteristics of oncologic patients with DNR decision at a tertiary hospital. Korean J Hosp Palliat Care 2016;19:26-33.
  12. Kim HA. Changes in life sustaining treatment of terminally Ill cancer patient after do-not-resuscitate decision [master's thesis]. Ulsan: Ulsan Univ.; 2014. Korean.
  13. Kang SY. Characteristics and nursing activities of DNR patients in emergency room of a tertiary care hospital [master's thesis]. Busan: Pusan Univ.; 2016. Korean.
  14. Kim DJ, Choi MS. Life-sustaining treatment and palliative care in patients with liver cirrhosis-legal, ethical, and practical issues. Clin Mol Hepatol 2017;23:115-22. https://doi.org/10.3350/cmh.2017.0018
  15. Choi JJ, Kim SH, Kim SW. Reversals in decisions about life-sustaining treatment and associated factors among older patients with terminal stage of cardiopulmonary disease. J Korean Acad Adult Nurs 2019;49:329-39.
  16. Kim SH. Family surrogates' decision regret and psychological stress about end-of-life cancer treatments: Path analysis. J Korean Acad Adult Nurs 2018;48:578-87.
  17. Han SY. A case study on Hospice Team's experience of the decision of patients' hospice and life sustaining treatments. Health Soc Welf Rev 2019;39:453-84.
  18. Auriemma CL, Nguyen CA, Bronheim R, Kent S, Nadiger S, Pardo D, et al. Stability of end-of-life preferences: A systematic review of the evidence. JAMA Int Med 2014;174:1085-92. https://doi.org/10.1001/jamainternmed.2014.1183
  19. Chavez G, Richman IB, Kaimal R, Bentley J, Yasukawa LA, Altman RB, et al. Reversals and limitations on high-intensity, life-sustaining treatments. PLoS One. 2018;13:e0190569. https://doi.org/10.1371/journal.pone.0190569
  20. Song MK, Ward SE, Hanson LC, Metzger M, Kim S. Determining consistency of surrogate decisions and end-of-life care received with patient goals-of-care preferences. J Palliat Med 2016;19:610-6.