Cancer Res Treat.  2020 Jul;52(3):917-924. 10.4143/crt.2019.740.

Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients

• Kim JS
• Yoo SH
• Choi W
• Kim Y
• Hong J
• Kim MS
• Park HY
• Keam B
• Heo DS

• KMID: 2504470
• DOI: http://doi.org/10.4143/crt.2019.740

Abstract

Purpose
Life-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. Itremains unclearwhetherthe act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement.
Materials and Methods
Retrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn.
Results
Of 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82)withdrewit. We found a higherwithdrawalratewhen family members made the decisions (13.3% vs. 1.7%, p < 0.001).
Conclusion
After the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.

Keyword

Withholding treatment; Palliative care; Advance directives

Figure

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  Fig. 1. Flow chart. SNUH, Seoul National University Hospital; DNR, do-not-resuscitate.

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  Fig. 2. Implementation status of life-sustaining treatment in the first year of the act's enforcement. (A) Withholding (n=727) or withdrawing (n=82) rate in total, and by decision-makers. (B) Proportions of the treatment which were withdrawn, such as cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), renal replacement therapy (RRT), and others.

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  Fig. 3. Status of critical care (%) such as cardiopulmonary resuscitation (A), mechanical ventilation (B), and renal replacement therapy (C), before and after documentation of the legal form 9.

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  Fig. 4. Intensive care unit (ICU) utilization in the last month of life in terminal cancer patients. (A) ICU admission rate by decision-makers in the first year of the act's enforcement. Admission patterns when patients (B) or family (C) members made decisions.

Reference

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