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http://dx.doi.org/10.14475/kjhpc.2020.23.2.93

End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience  

Jin, Sol (Department of Internal medicine, Kosin University Gospel Hospital)
Kim, Jehun (Department of Pulmonology, Kosin University Gospel Hospital)
Lee, Jin Young (Department of Infectious disease, Kosin University Gospel Hospital)
Ko, Taek Yong (Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital)
Oh, Gyu Man (Department of Internal medicine, Kosin University Gospel Hospital)
Publication Information
Journal of Hospice and Palliative Care / v.23, no.2, 2020 , pp. 93-102 More about this Journal
Abstract
Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.
Keywords
Advance care planning; Terminal care; Korea;
Citations & Related Records
Times Cited By KSCI : 4  (Citation Analysis)
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1 Yun YH. Hospice-palliative care and social strategies for improvement of the quality of end-of-life. J Korean Med Assoc 2009;52:880-5.   DOI
2 Kim M. The problems and the improvement plan of the hospice/palliative care and dying patient's decisions on life-sustaining treatment act. Korean J Hosp Palliat Care 2018;21:1-8.
3 Koh YK. Current status of end-of-life care in Korean hospitals. J Korean Med Assoc 2012;55:1171-7.   DOI
4 Kim JM, Baek SK, Kim SY, Maeng CH. Comparison of end-of-life care intensity between cancer and non-cancer patients: a single center experience. Korean J Hosp Palliat Care 2015;18:322-8.
5 Yoon SE, Nam EM, Lee SN. End-of-life care practice in dying patients with do-not-resuscitate order: a single center experience. Korean J Hosp Palliat Care 2018;21:51-7.
6 Tang ST, Liu TW, Lai MS, Liu LN, Chen CH. Concordance of preferences for end-of-life care between terminally ill cancer patients and their family caregivers in Taiwan. J Pain Symptom Manage 2005;30:510-8.   DOI
7 Holroyd EE. Chinese family obligations toward chronically ill elderly members: comparing caregivers in Beijing and Hong Kong. Qual Health Res 2003;13:302-18.   DOI
8 Koh YS, Heo DS, Yun YH, Moon JL, Park HW, Choung JT, et al. Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy. J Korean Med Assoc 2011;54:747-57.   DOI
9 National Agency for Management of Life-sustaining Treatment [Internet]. Monthly statistics. Seoul: KoNIBP; 2019 [cited 2020 May 10]. Available from: https://www.lst.go.kr.