Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea

Abstract

This study aimed to confirm the decision-making patterns for life-sustaining treatment and analyze medical service utilization changes after enforcement of the Life-Sustaining Treatment Decision-Making Act. Materials and MethodsOf 1,237 patients who completed legal forms for life-sustaining treatment (hereafter called the life-sustaining treatment [LST] form) at three academic hospitals and died at the same institutions, 1,018 cancer patients were included. Medical service utilization and costs were analyzed using claims data. ResultsThe median time to death from completion of the LST form was three days (range, 0 to 248 days). Of these, 517 people died within two days of completing the document, and 36.1% of all patients prepared the LST form themselves. The frequency of use of the intensive care unit, continuous renal replacement therapy, and mechanical ventilation was significantly higher when the families filled out the form without knowing the patient's intention. In the top 10% of the medical expense groups, the decision-makers for LST were family members rather than patients (28% patients vs. 32% family members who knew and 40% family members who did not know the patient's intention). ConclusionThe cancer patient's own decision-making rather than the family's decision was associated with earlier decision-making, less use of some critical treatments (except chemotherapy) and expensive evaluations, and a trend toward lower medical costs.

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

“…Even after the implementation of the life-sustaining-treatment act, there have been cases where patients who had written an advance directive were admitted to the intensive care unit and received a similar level of intervention as patients without an advance directive. In Korea, ICU hospitalization and invasive interventions often occur against the patient’s wishes, especially if the family is unaware of or does not agree with the patient’s wishes regarding end-of-life care [ 33 ]. Therefore, it is important for healthcare providers to discuss POLST with both patients and families prior to ICU admission to clarify the meaning and scope of treatment.…”

For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act

“…With the estimation of EoL patients that followed the process required by the Act only as 20–25%, 9 several studies found that the use of intensive care unit hospitalization, ventilator, and cardiopulmonary resuscitation did not differ after legalization, suggesting that this restriction may lead to potential delays in avoiding LST. 19 20 21 It may be an excessive violation of the rights of EoL patients who have not been judged as being actively dying despite the burden of treatment and goal of care at the terminal phase are not significantly different compared to the dying phase. Moreover, when a patient has a non-cancerous condition, such as organ failure or dementia, these limitations are more pronounced, as distinguishing the dying phase from the terminal phase is challenging.…”

Development and Feasibility Evaluation of Smart Cancer Care 2.0 Based on Patient-Reported Outcomes for Post-Discharge Management of Patients with Cancer

“…As the system gains usage experience, the characteristics of collected PROs need analysis, including adjustments to the number of monitored symptoms (and variables) and alleviate chemotherapy-related anxiety [19], whereas Smart Cancer Care 2.0, addressing all aspects of cancer treatment, is expected to enhance patients' learning and self-efficacy. This could facilitate the adoption of shared decision-making in the broader field of cancer treatment [25,26]. From healthcare workers' perspectives, Smart Cancer Care 2.0 is anticipated to aid in forming a rapport with patients and providing personalized treatment, as evidenced by the feasibility evaluation score, which is higher than that of patients.…”