Cancer Res Treat.  2021 Apr;53(2):593-600. 10.4143/crt.2020.803.

A National Study of Life-Sustaining Treatments in South Korea: What Factors Affect Decision-Making?

• Park SY
• Lee B
• Seon JY
• Oh IH

• KMID: 2514940
• DOI: http://doi.org/10.4143/crt.2020.803

Abstract

Purpose
This cross-sectional study investigated the status of life-sustaining treatment (LST) practices and identified characteristics and factors influencing decision-making practices.
Materials and Methods
The National Agency for Management of Life-sustaining Treatment retains records provided by doctors regarding patients subject to LST implementation. A total of 71,327 patients receiving LST were identified. We analyzed all nationally reported data between February 2018 and October 2019. Indicators such as the proportion of deaths, records for decision to terminate LST, implementation of LST records, and registration of Advance Statements on LST were analyzed.
Results
A total of 67,252 (94.3%) end-of life decisions were implemented in South Korea. The proportion of deaths preceded by a LST plan, non-self-determination LST decision, and any advance statements was 33.5% (23,891/71,327), 66.5% (47,436/71,327), and 1.2% (890/71,327), respectively. The logistic regression model revealed that self-determination to terminate LST was more frequent for men than for women and higher for those aged 30-69. Disability (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.56 to 0.61), living in non-metropolitan areas (OR, 0.84; 95% CI, 0.81 to 0.86), and disease comorbidity was independently associated with a low level of self-determination.
Conclusion
After the implementation of the new LST Act, about a third of patients in end-of-life process made decisions regarding their medical LST. However, family members still play a major role in LST decisions where the patient’s intention cannot be verified. Decisions related to LST are predominantly made when death is imminent. Thus, it is necessary to increase awareness of end-of-life LST decision-making among medical staff and the public.

Keyword

Palliative care; Personal autonomy; Medical staff; Terminal care; Hospice; Cross-sectional studies

Figure

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  Fig. 1 Patient selection process to analyze factors influencing patient-centered decision to terminate life-sustaining treatment. a)Population aged ≥ 19 years: 2019 Statistics Korea Projected Population.

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  Fig. 2 Percentage of self-determination life-sustaining treatment among patients in end-of-life care according to the patient determination form.

Reference

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