Cancer Res Treat.  2021 Apr;53(2):584-592. 10.4143/crt.2020.735.

Difficulties Doctors Experience during Life-Sustaining Treatment Discussion after Enactment of the Life-Sustaining Treatment Decisions Act: A Cross-Sectional Study

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

• KMID: 2514939
• DOI: http://doi.org/10.4143/crt.2020.735

Abstract

Purpose
This study aimed to investigate difficulties doctors experience during life-sustaining treatment (LST) discussion with seriously ill patients and their families after enactment of the LST Decisions Act in February 2018.
Materials and Methods
A cross-sectional survey was conducted in a tertiary hospital in the Republic of Korea in August 2019. Six hundred eighty-six doctors who care for seriously ill patients were given a structured questionnaire, and difficulties during the discussion were examined.
Results
One hundred thirty-two doctors completed the questionnaire. Eighty-five percent answered they treat cancer patients. Most (86.4%) experienced considerable difficulties during LST discussions (mean score, 7.4±1.6/10). The two most common difficulties were communication with patients and family and determining when to discuss LST. Two-thirds of doctors found direct discussions with the patient difficult and said they would initiate LST discussions only with family. LST discussions were actually initiated later than considered appropriate. When medically assessing whether the patient is imminently dying, 56% of doctors experienced disagreements with other doctors, which could affect their decisions.
Conclusion
This study found that most doctors experienced serious difficulties regarding communication with patients and family and medical assessment of dying process during LST discussions. To alleviate these difficulties, further institutional support is needed to improve the LST discussion between doctors, patients, and family.

Keyword

End-of-life care; Terminal cancer; Discussion; Decision making; Life-sustaining treatment

Figure

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  Fig. 1 The timing of life-sustaining treatment (LST) discussions and strategies to facilitate the discussion at an earlier time. (A) The appropriate time for initiating LST discussions and the actual time of discussion. (B) Attitudes toward the strategy to necessitate LST discussions when the patient visits an emergency room or has unplanned hospitalization. (C) Attitudes toward the strategy to include the explanation for LST discussions in the consent form before a procedure or an operation with risk of death.

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  Fig. 2 Discrepancy or disagreement in medical assessment of the patient in the end-of-life (EOL) process. (A) Response to the question “Is there a discrepancy between when the patient or family thought the patient is in the EOL process and the doctor’s assessment?” (B) Response to the question “How often do you experience disagreement with other doctors regarding medical assessment of the patient in the EOL process?” (C) The impact of discrepancy between doctor and patient/family and (D) the impact of disagreement between doctors on the decision-making process on life-sustaining treatment.

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  Fig. 3 Response to case 1 based on the previous intention of the patient: “In case the patient is currently unable to express their intention, what would you do if the family wants a ventilator even though you consider it a medically inappropriate life-sustaining treatment (LST)?”

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  Fig. 4 Response to case 2: “You know that your patient has stated that he or she does not want life-sustaining treatment (LST) but has no written Advance Directives or LST Plan yet. What would you do if the patient who was never determined to be in the end-of-life process had a sudden cardiac arrest?”

Reference

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