Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment: A Focus on Deceased Patients with Hematologic Neoplasms

  • Jae Eun Jang (Hematology Intensive Care Unit, The Catholic University of Korea) ;
  • Jeong Moon Ryu (Hematology Intensive Care Unit, The Catholic University of Korea) ;
  • Min Hee Heo (Hematology Intensive Care Unit, The Catholic University of Korea) ;
  • Do Eun Kwon (Hematology Intensive Care Unit, The Catholic University of Korea) ;
  • Ji Yeon Seo (Hematology Intensive Care Unit, The Catholic University of Korea) ;
  • Dong Yeon Kim (Nursing Innovation Unit, The Catholic University of Korea)
  • Received : 2023.03.05
  • Accepted : 2023.04.17
  • Published : 2023.06.01
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Abstract

Purpose: This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods: A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results: In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion: The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

Keywords

Acknowledgement

This study was supported by the research fund of Seoul St. Mary's Hospital, the Catholic University of Korea.

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