Completion rate of physician orders for life-sustaining treatment for patients with metastatic or recurrent cancer: a preliminary, cross-sectional study

Kim, Ju Won; Choi, Jung Yoon; Jang, Won Jin; Choi, Yoon Ji; Choi, Youn Seon; Shin, Sang Won; Kim, Yeul Hong; Park, Kyong Hwa

doi:10.1186/s12904-019-0475-9

Cited by 13 publications

(24 citation statements)

References 16 publications

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“…25,58 Our findings also show that patients were willing to initiate advance care planning at a particular time in the future or later in the course of their illness. 25,28,33,35,37,38,50,56 With regard to patients' preferences for documenting their conversations, our findings were varied: while some preferred a written document, 24,31,34,54 others preferred verbal communication with their family, and/or healthcare professionals without drafting or signing a written document. 29,43,44,57…”

Section: Behavioral Beliefsmentioning

confidence: 86%

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

et al. 2021

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Background: Asian healthcare professionals hold that patients’ families play an essential role in advance care planning. Aim: To systematically synthesize evidence regarding Asian patients’ perspectives on advance care planning and their underlying motives. Design: Mixed-method systematic review and the development of a conceptual framework (PROSPERO: CRD42018099980). Data sources: EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for studies published until July 27, 2020. We included studies concerning seriously-ill Asian patients’ perspectives on advance care planning or their underlying motives for engaging or not engaging in it. Results: Thirty-six articles were included; 22 were quantitative and 27 were from high-income countries. Thirty-nine to ninety percent of Asian patients were willing to engage in advance care planning. Our framework highlighted that this willingness was influenced not only by their knowledge of their disease and of advance care planning, but also by their beliefs regarding: (1) its consequences; (2) whether its concept was in accordance with their faith and their families’ or physicians’ wishes; and (3) the presence of its barriers. Essential considerations of patients’ engagement were their preferences: (1) for being actively engaged or, alternatively, for delegating autonomy to others; (2) the timing, and (3) whether or not the conversations would be documented. Conclusion: The essential first step to engaging patients in advance care planning is to educate them on it and on their diseases. Asian patients’ various beliefs about advance care planning should be accommodated, especially their preferences regarding their role in it, its timing, and its documentation.

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Section: Behavioral Beliefsmentioning

confidence: 86%

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

et al. 2021

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“…Therefore, the author doubted the real possibility of the universal application of patient autonomy for cancer patients in Korea. After 10 years, another study investigated a similar issue under the current LST law [ 22 ]. Here, 71.3% of the advanced cancer patients were willing to have a conversation related to LST with their physicians.…”

Section: Discussionmentioning

confidence: 99%

“…This finding was similar to the preference analysis of cancer patients toward the selection of LST on legal form No. 13 [ 22 ]. Among the patients who signed the form, only 31.9% wanted to stop chemotherapy, whereas all 72 participants refused CPR and mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…A previous study on intensive care unit doctors in Asia reported that among the factors that these doctors considered to be important in making LST-related decisions, the needs of the family accounted for 77.9%; it was only surpassed by the factors patient’s intention (84.1%) and long-term quality of life [ 3 ]. It is well-established fact that the physician’s perception of the intention of the family and the preference of the patient may sometimes be different than the patient’s original intention [ 1 , 20 , 21 ]. Personal characteristics or experience of the physician could also influence LST-related decisions, which inherently presents the risk of a decision being made contrary to the patient’s intention [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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 (OR: 0.59, 95% CI: 0.56-0.61), living in non-metropolitan areas (OR: 0.84, 95% CI: 0.81-0.86), and disease comorbidity was independently associated with a low level of selfdetermination. 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 CANCER RESEARCH AND TREATMENT (CRT) 3 Korean Cancer Association This article is protected by copyright. All rights reserved. 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.

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Completion rate of physician orders for life-sustaining treatment for patients with metastatic or recurrent cancer: a preliminary, cross-sectional study

Cited by 13 publications

References 16 publications

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

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

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

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