Cancer Res Treat.  2021 Oct;53(4):897-907. 10.4143/crt.2021.327.

The Situation of Life-Sustaining Treatment One Year after Enforcement of the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life in Korea: Data of National Agency for Management of Life-Sustaining Treatment

• Lee HY
• Kim HJ
• Kwon JH
• Baek SK
• Won YW
• Kim YJ
• Baik SJ
• Ryu H

• KMID: 2521566
• DOI: http://doi.org/10.4143/crt.2021.327

Abstract

Purpose
The “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life” was enacted on February 3, 2016 and went into effect on February 4, 2018 in Korea. This study reviewed the first year of determination to life-sustaining treatment (LST) through data analysis of the National Agency for Management of Life-Sustaining Treatment.
Materials and Methods
The National Agency for Management of LST provided data between February 4, 2018 and January 31, 2019 anonymously from 33,549 patients. According to the forms patients were defined as either elf-determinants or family-determinants.
Results
The median age of the patient was 73 and the majority was male (59.9%). Cancer patients were 59% and self-determinants were 32.1%. Cancer patients had a higher rate of self-determinants than non-cancer (47.3% vs. 10.1%). Plan for hospice service was high in cancer patients among self-determinants (81.0% vs. 37.5%, p < 0.001). In comparison to family-determinants, self-determinants were younger (median age, 67 years vs. 75 years; p < 0.001) and had more cancer diagnosis (87.1% vs. 45.9%, p < 0.001). Decision of withholding or withdrawing of LSTs in cancer patients was higher than non-cancer patients in four items.
Conclusion
Cancer patients had a higher rate in self-determination and withholding or withdrawing of LSTs than non-cancer patients. Continued revision of the law and education of the public will be able to promote withdrawing or withholding the futile LSTs in patients at end-of-life. Further study following the revision of the law should be evaluated to change of end-of-life care.

Keyword

Terminal care; Hospices; Advance directives; Withholding treatment

Figure

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  Fig. 1 Patient cohort.

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  Fig. 2 Distribution of patient residence and hospital location.

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  Fig. 3 Forest plots of inconsistency rate of four items of LST decisions between form 1 and form 13. CI, confidence interval; CPR, cardiopulmonary resuscitation; CTx, anticancer drugs; HD, hemodialysis; LST, life-sustaining treatment; MV, mechanical ventilation.

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  Fig. 4 Comparison of implementation of four items of life-sustaining treatment decisions between self-determinants and family-determinants. CPR, cardiopulmonary resuscitation.

Reference

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