Browse > Article
http://dx.doi.org/10.14475/jhpc.2022.25.1.12

Comparing Perceptions, Determinants, and Needs of Patients, Family Members, Nurses, and Physicians When Making Life-Sustaining Treatment Decisions for Patients with Hematologic Malignancies  

Kim, Semi (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Ham, Eun Hye (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Kim, Dong Yeon (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Jang, Seung Nam (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Kim, Min kyeong (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Choi, Hyun Ah (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Cho, Yun A (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Lee, Seung A (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Yun, Min Jeong (Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital)
Publication Information
Journal of Hospice and Palliative Care / v.25, no.1, 2022 , pp. 12-24 More about this Journal
Abstract
Purpose: This descriptive study compared the perceptions, determinants, and needs of patients, family members, nurses, and physicians regarding life-sustaining treatment decisions for patients with hematologic malignancies in the hematology-oncology department of a tertiary hospital in Seoul, Korea. Methods: In total, 147 subjects were recruited, gave written consent, and provided data by completing a structured questionnaire. Data were analyzed using analysis of variance, the chi-square test, and the Fisher exact test. Results: Nurses (F=3.35) and physicians (F=3.57) showed significantly greater familiarity with the Act on Decisions on Life-Sustaining Treatment than patients (F=2.69) and family members (F=2.59); (F=19.58, P<0.001). Many respondents, including 19 (51.4%) family members, 16 (43.2%) physicians, and 11 (29.7%) nurses, agreed that the patient's opinion had the greatest effect when making life-sustaining treatment decisions. Twelve (33.3%) patients answered that mental, physical, and financial burdens were the most important factors in life-sustaining treatment decisions, and there was a significant difference among the four groups (P<0.001). Twenty-four patients (66.7%), 27 (73.0%) family members, and 21(56.8%) nurses answered that physicians were the most appropriate people to provide information regarding life-sustaining treatment decisions. Unexpectedly, 19 (51.4%) physicians answered that hospice nurse practitioners were the most appropriate people to talk to about life-sustaining treatment (P<0.001). Conclusion: It is of utmost importance that the patient and physician determine when life-sustaining treatment should be withdrawn, with the patient making the ultimate decision. Doctors and nurses have the responsibility to provide detailed information. The goal of end-of-life planning is to ensure patients' dignity and respect their values.
Keywords
Perceptions; Terminal care; Life support care; Decision making; Hematologic neoplasms; Palliative care; Communication;
Citations & Related Records
Times Cited By KSCI : 8  (Citation Analysis)
연도 인용수 순위
1 Park AR, So HS, Chae MC. Recognition of patients, families, nurses, and physicians about clinical decision-making and biomedical ethics. AON 2014;14:23-31.
2 Kim Y. Signification and challenges of the act on life-prolongation determination - with focus on patient-oriented medical care. Korean J Health Community 2018;13:53-61.
3 Hwang HY, Yang SJ. A comparative study on the perceptions of elderly patients and their caregivers toward life-sustaining treatment. Korean J Med Ethics 2016;19:484-503.   DOI
4 Lee SH, Shin DE, Sim JA, Yun YH. Public perception and acceptance of the national strategy for well-dying. Korean J Hosp Palliat Care 2013;16:90-7.   DOI
5 Jung HJ, Park JY. Life-sustaining treatment in end-stage liver disease patients: Patients' decisions and results. Korean J Hosp Palliat Care 2020;23:85-92.   DOI
6 Sun DS, Chun YJ, Lee JH, Gil SH, Shim BY, Lee OK, et al. Recognition of advance directives by advanced cancer patients and medical doctors in hospice care ward. Korean J Hosp Palliat Care 2009;12:20-6.   DOI
7 Lee SJ, Kim HY. Attitude, role perception and nursing stress on life sustaining treatment among intensive care unit nurses. KJAN 2017;29:131-42.   DOI
8 Choi SY, Kim KH. The influence of moral sensitivity, knowledge of advanced directives, good death Perception on nurses' attitudes toward the withdrawal of life-sustaining treatment in a general hospital. Korean J Rehabil Nurs 2020;23:120-31.   DOI
9 Cho KH, Park YK, Suh SR. Comparison of the death anxiety and preferences for care near the end of life between nurses and physicians. Korean J Med Ethics 2017;20:276-86.   DOI
10 Kim KS, Kim SM, Hong SW, Kim JS. The evaluation of the Korean Advance Directives (K-AD). Korean J Hosp Palliat Care 2016;19:109-18.   DOI
11 Jo KH, An GJ, Kim GM. A factor analysis of the impediments to end-stage medical decision-making as perceived by nurses and physicians in South Korea. Korean J Med Ethics 2011;14:427-42.   DOI
12 Law No. 18627 : Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life [Internet]. Seoul: The National Assembly of the Republic of Korea; 2021. Dec 21 [cited 2021 Dec 21]. Available from: https://www.law.go.kr.
13 Lee SR, Shin D, Choi Y. Perceptions of caregivers and medical staff toward DNR and AD. Korean J Hosp Palliat Care 2014;17:66-74.   DOI
14 Kwak SY, Byeon YS. Factors influencing resilience of patients with hematologic malignancy. J Korean Acad Soc Adult Nurs 2013;25:95-104.   DOI
15 Choi YN, Song Y. Life-sustaining treatment choices and related factors involving hospital nurses. J Korean Public Health Nurs 2018;32:167-80.   DOI
16 Kim SN, Kim HJ. Recognition of good death, attitude towards the withdrawal of life-sustaining treatment, and attitude towards euthanasia in nurses. Korean J Hosp Palliat Care 2016;19:136-44.   DOI
17 Atkinson Smith M, Torres L, Burton TC. Patient rights at the end of life: The ethics of aid-in-dying. Prof Case Manag 2020;25:77-84.   DOI
18 Yun YH, Rhee YS, Nam SY, Chae YM, Heo DS, Lee SY, et al. Public attitudes toward dying with dignity and hospice palliative care. Korean J Hosp Palliat Care 2004;7:17-28.
19 Kim MH, Kang EH, Kim MY. Family decision-making to withdraw life-sustaining treatment for terminally-ill patients in an unconscious state. Korean J Hosp Palliat Care 2012;15:147-54.   DOI
20 Kwon BG, Koh YS, Yun YH, Heo DS, Seo SY, Kim HC, et al. A study of the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients in Korea. Korean J Med Ethics 2010;13:1-16.   DOI
21 Kirby E, Broom A, Good P. The role and significance of nurses in managing transitions to palliative care: a qualitative study. BMJ Open 2014;4:e006026.   DOI
22 Jang NS, Park HS, Kim MR, Lee JY, Cho YW, Kim KM, et al. Knowledge, confidence, and learning needs regarding advance directives among hospital nurses. J Korean Crit Care Nurs 2018;11:35-45.
23 Visser M, Deliens L, Houttekier D. Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review. Critical Care 2014;18:604.   DOI
24 Ruijs CD, Kerkhof AJ, van der Wal G, Onwuteaka-Philipsen BD. The broad spectrum of unbearable suffering in end-of-life cancer studied in dutch primary care. BMC Palliative Care 2012;11:12.   DOI
25 Shin DW, Lee JE, Cho BL, Yoo SH, Kim SY, Yoo JH. End-of-life communication in Korean older adults: with focus on advance care planning and advance directives. Geriatr Gerontol Int 2016;16:407-15.   DOI
26 Kang JS, Kim HO. The effect of video education on cancer patient advance directive writing. AON 2020;20:39-49.