Cancer Res Treat.  2025 Jan;57(1):280-288. 10.4143/crt.2024.360.

Factors Affecting Life-Sustaining Treatment Decisions and Changes in Clinical Practice after Enforcement of the Life-Sustaining Treatment (LST) Decision Act: A Tertiary Hospital Experience in Korea

• Jang YJ
• Yang YJ
• Koo HJ
• Yoon HW
• Uhm S
• Kim SY
• Kim JE
• Huh JW
• Kim TW
• Seo S

• KMID: 2564600
• DOI: http://doi.org/10.4143/crt.2024.360

Abstract

Purpose
In Korea, the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment (LST) was implemented on February 4, 2018. We aimed to investigate relevant factors and clinical changes associated with LST decisions after law enforcement.
Materials and Methods
This single-center retrospective study included patients who completed LST documents using legal forms at Asan Medical Center from February 5, 2018, to June 30, 2020.
Results
5,896 patients completed LST documents, of which 2,704 (45.8%) signed the documents in person, while family members of 3,192 (54%) wrote the documents on behalf of the patients. Comparing first year and following year of implementation of the act, the self-documentation rate increased (43.9% to 47.2%, p=0.014). Moreover, the number of LST decisions made during or after intensive care unit admission decreased (37.8% vs. 35.2%, p=0.045), and the completion rate of LST documents during chemotherapy increased (6.6% vs. 8.9%, p=0.001). In multivariate analysis, age < 65 (odds ratio [OR], 1.724; 95% confidence interval [CI], 1.538 to 1.933; p < 0.001), unmarried status (OR, 1.309; 95% CI, 1.097 to 1.561; p=0.003), palliative care consultation (OR, 1.538; 95% CI, 1.340 to 1.765; p < 0.001), malignancy (OR, 1.864; 95% CI, 1.628 to 2.133; p < 0.001), and changes in timing on the first year versus following year (OR, 1.124; 95% CI, 1.003 to 1.260; p=0.045) were related to a higher self-documentation rate.
Conclusion
Age < 65 years, unmarried status, malignancy, and referral to a palliative care team were associated with patients making LST decisions themselves. Furthermore, the subject and timing of LST decisions have changed with the LST act.

Keyword

Palliative care; Hospice care; Withholding; Withdrawing; Life-sustaining treatment

Figure

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  Fig. 1. Flowchart of changes over time of life-sustaining treatment (LST) decision maker. FORM 1 was completed by patients; FORM 11 was completed by family members based on patients’ opinions; FORM 12 was completed by family members based on the consensus of all f irst-degree family members. Group 1: patients whose LST decision documents were completed within 1 year of law enforcement; Group 2: patients whose LST decision documents were completed 1 year after law enforcement.

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  Fig. 2. Changes in life-sustaining treatment (LST) decision type after enforcement of the act. The rate of self-determination (FORM 1) significantly increased, whereas the rate of family determination (FORM 12) significantly decreased over time. FORM 1 was completed by patients; FORM 11 was completed by family members based on patients’ opinions; FORM 12 was completed by family members based on the consensus of all f irst-degree family members. Group 1: patients whose LST decision documents were completed within 1 year of law enforcement; Group 2: patients whose LST decision documents were completed 1 year after law enforcement.

Reference

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