Cancer Research and Treatment

Original Articles

General

Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea: Dalyong Kim, Shin Hye Yoo, Seyoung Seo, Hyun Jung Lee, Min Sun Kim, Sung Joon Shin, Chi-Yeon Lim, Do Yeun Kim, Dae Seog Heo, Chae-Man Lim; Cancer Res Treat. 2022;54(1):20-29. Published online April 12, 2021; DOI: https://doi.org/10.4143/crt.2021.131

Purpose
This study aimed to confirm the decision-making patterns for life-sustaining treatment (LST) and analyze medical service utilization changes after enforcement of the Life-Sustaining Treatment Decision-Making Act.
Materials and Methods
Of 1,237 patients who completed legal forms for life-sustaining treatment (hereafter called the 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.
Results
The 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).
Conclusion
The 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.

Citations

Citations to this article as recorded by

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
Yoon Jung Jang, Yun Jung Yang, Hoi Jung Koo, Hye Won Yoon, Seongbeom Uhm, Sun Young Kim, Jeong Eun Kim, Jin Won Huh, Tae Won Kim, Seyoung Seo
Cancer Research and Treatment.2025; 57(1): 280. CrossRef
Characteristics of Life-Sustaining Treatment Decisions: National Data Analysis in South Korea
Jiyeon Choi, Heejung Jeon, Ilhak Lee
Asian Bioethics Review.2024; 16(1): 33. CrossRef
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
Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
BMC Palliative Care.2024;[Epub] CrossRef
For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act
Hye Yoon Park, Min Sun Kim, Shin Hye Yoo, Jung Lee, In Gyu Song, So Yeon Jeon, Eun Kyung Choi
Journal of Korean Medical Science.2024;[Epub] CrossRef
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
Acute and Critical Care.2024; 39(2): 294. CrossRef
Nurses' engagement in advance care planning practices: A descriptive cross‐sectional study
Sangmin Lee, Naixue Cui, Hyejin Kim
Journal of Clinical Nursing.2024;[Epub] CrossRef
Issues and implications of the life-sustaining treatment decision act: comparing the data from the survey and clinical data of inpatients at the end-of-life process
Eunjeong Song, Dongsoon Shin, Jooseon Lee, Seonyoung Yun, Minjeong Eom, Suhee Oh, Heejung Lee, Jiwan Lee, Rhayun Song
BMC Medical Ethics.2024;[Epub] CrossRef
Development and Feasibility Evaluation of Smart Cancer Care 2.0 Based on Patient-Reported Outcomes for Post-Discharge Management of Patients with Cancer
Jin Ah Kwon, Songsoo Yang, Su-Jin Koh, Young Ju Noh, Dong Yoon Kang, Sol Bin Yang, Eun Ji Kwon, Jeong-Wook Seo, Jin sung Kim, Minsu Ock
Cancer Research and Treatment.2024; 56(4): 1040. CrossRef
Advance Care Planning in South Korea
Yu Jung Kim, Sun-Hyun Kim
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68. CrossRef
Preferred versus Actual Place of Care and Factors Associated with Home Discharge among Korean Patients with Advanced Cancer: A Retrospective Cohort Study
In Young Hwang, Yohan Han, Min Sun Kim, Kyae Hyung Kim, Belong Cho, Wonho Choi, Yejin Kim, Shin Hye Yoo, Sun Young Lee
Healthcare.2023; 11(13): 1939. CrossRef

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11 Web of Science
10 Crossref

Palliative medicine

Difficulties Doctors Experience during Life-Sustaining Treatment Discussion after Enactment of the Life-Sustaining Treatment Decisions Act: A Cross-Sectional Study: Shin Hye Yoo, Wonho Choi, Yejin Kim, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo; Cancer Res Treat. 2021;53(2):584-592. Published online November 19, 2020; DOI: https://doi.org/10.4143/crt.2020.735

Abstract PDF PubReader ePub

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.

Citations

Citations to this article as recorded by

Nurses' engagement in advance care planning practices: A descriptive cross‐sectional study
Sangmin Lee, Naixue Cui, Hyejin Kim
Journal of Clinical Nursing.2024;[Epub] CrossRef
Navigating shared decision-making after the Life-Sustaining Treatment Decision Act: a qualitative study of in-depth interviews with terminal cancer patients, families, and healthcare professionals
Soo-Young Yu, Yu-eun Lee, Sung Joon Shin, Go-un Woo, Dalyong Kim, Jung Hye Kwon, Do Yeun Kim, Eunyoung Eunice Suh
Supportive Care in Cancer.2024;[Epub] CrossRef
Advance Care Planning in Palliative Care in Asia: Barriers and Implications
Yoo Jeong Lee, Sun-Hyun Kim, Shin Hye Yoo, A-Sol Kim, Cheng-Pei Lin, Diah Martina, Masanori Mori, Sang-Yeon Suh
Journal of Hospice and Palliative Care.2024; 27(4): 107. CrossRef
Use of high‐flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life
Jung Sun Kim, Jeongmi Shin, Nam Hee Kim, Sun Young Lee, Shin Hye Yoo, Bhumsuk Keam, Dae Seog Heo
Cancer Medicine.2023; 12(13): 14612. CrossRef
Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act
Shin Hye Yoo, Yejin Kim, Wonho Choi, Jeongmi Shin, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Jae-Joon Yim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Advance Care Planning in South Korea
Yu Jung Kim, Sun-Hyun Kim
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68. CrossRef
Physicians’ attitudes and experiences about withholding/withdrawing life-sustaining treatments in pediatrics: a systematic review of quantitative evidence
Yajing Zhong, Alice Cavolo, Veerle Labarque, Chris Gastmans
BMC Palliative Care.2023;[Epub] CrossRef
Public awareness of advance care planning and hospice palliative care: a nationwide cross-sectional study in Korea
Boram Kim, Junyong Lee, Youn Seon Choi
BMC Palliative Care.2023;[Epub] CrossRef
Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea
Dalyong Kim, Shin Hye Yoo, Seyoung Seo, Hyun Jung Lee, Min Sun Kim, Sung Joon Shin, Chi-Yeon Lim, Do Yeun Kim, Dae Seog Heo, Chae-Man Lim
Cancer Research and Treatment.2022; 54(1): 20. CrossRef
Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence
Yajing Zhong, Alice Cavolo, Veerle Labarque, Chris Gastmans
BMC Palliative Care.2022;[Epub] CrossRef
Association of perceived life satisfaction with attitudes toward life-sustaining treatment among the elderly in South Korea: a cross-sectional study
Il Yun, Hyunkyu Kim, Eun-Cheol Park, Suk-Yong Jang
BMC Palliative Care.2022;[Epub] CrossRef
Awareness of Doctors’ Shared Decision-Making in Life-Sustaining Care Decisions
Dalyong Kim, Hyun Jung Lee, Soo-Young Yu, Jung Hye Kwon, Hee Kyung Ahn, Jee Hyun Kim, Seyoung Seo, Chi Hoon Maeng, Seungtaek Lim, Do Yeun Kim, Sung Joon Shin
The Korean Journal of Hospice and Palliative Care.2021; 24(4): 204. CrossRef

6,981 View
111 Download
9 Web of Science
12 Crossref

Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients: Jung Sun Kim, Shin Hye Yoo, Wonho Choi, Yejin Kim, Jinui Hong, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo; Cancer Res Treat. 2020;52(3):917-924. Published online March 23, 2020; DOI: https://doi.org/10.4143/crt.2019.740

Abstract PDF PubReader ePub

Purpose
Life-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. Itremains unclear whether the act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement.
Materials and Methods
Retrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn.
Results
Of 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82)withdrew it. We found a higher withdrawal rate when family members made the decisions (13.3% vs. 1.7%, p < 0.001).
Conclusion
After the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.

Citations

Citations to this article as recorded by

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
Yoon Jung Jang, Yun Jung Yang, Hoi Jung Koo, Hye Won Yoon, Seongbeom Uhm, Sun Young Kim, Jeong Eun Kim, Jin Won Huh, Tae Won Kim, Seyoung Seo
Cancer Research and Treatment.2025; 57(1): 280. CrossRef
Development of Public Health Center‐Based Culturally Tailored Hypertension Self‐Care Intervention Among Adults in Rural Ghana
Kennedy Diema Konlan, Hyeonkyeong Lee, Yeonsoo Jang, Seung Eun Lee, Soyoon Kim
Public Health Nursing.2025;[Epub] CrossRef
Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021
Seung Hwan Kim, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Taek Min Nam
Journal of Korean Neurosurgical Society.2024; 67(1): 73. CrossRef
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
Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
BMC Palliative Care.2024;[Epub] CrossRef
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
Acute and Critical Care.2024; 39(2): 294. CrossRef
End-of-life care in the intensive care unit: the optimal process of decision to withdrawing life-sustaining treatment based on the Korean medical environment and culture
Ho Jin Yong, Dohhyung Kim
Acute and Critical Care.2024; 39(2): 321. CrossRef
Inpatient Hospice Care in Korea during the COVID-19 Pandemic: A Preliminary Study
Youn Seon Choi, Sun Wook Hwang, In Cheol Hwang
Journal of Hospice and Palliative Care.2024; 27(2): 82. CrossRef
Issues and implications of the life-sustaining treatment decision act: comparing the data from the survey and clinical data of inpatients at the end-of-life process
Eunjeong Song, Dongsoon Shin, Jooseon Lee, Seonyoung Yun, Minjeong Eom, Suhee Oh, Heejung Lee, Jiwan Lee, Rhayun Song
BMC Medical Ethics.2024;[Epub] CrossRef
Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019
Sun Young Lee, Young Sun Ro, Sang Do Shin, Eunsil Ko, Seong Jung Kim
Scientific Reports.2023;[Epub] CrossRef
Modification of termination of resuscitation rule with compression time interval in South Korea
Song Yi Park, Daesung Lim, Ji Ho Ryu, Yong Hwan Kim, Byungho Choi, Sun Hyu Kim
Scientific Reports.2023;[Epub] CrossRef
Use of high‐flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life
Jung Sun Kim, Jeongmi Shin, Nam Hee Kim, Sun Young Lee, Shin Hye Yoo, Bhumsuk Keam, Dae Seog Heo
Cancer Medicine.2023; 12(13): 14612. CrossRef
Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment: A Focus on Deceased Patients with Hematologic Neoplasms
Jae Eun Jang, Jeong Moon Ryu, Min Hee Heo, Do Eun Kwon, Ji Yeon Seo, Dong Yeon Kim
The Korean Journal of Hospice and Palliative Care.2023; 26(2): 69. CrossRef
Advance Care Planning in South Korea
Yu Jung Kim, Sun-Hyun Kim
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68. CrossRef
Preferred versus Actual Place of Care and Factors Associated with Home Discharge among Korean Patients with Advanced Cancer: A Retrospective Cohort Study
In Young Hwang, Yohan Han, Min Sun Kim, Kyae Hyung Kim, Belong Cho, Wonho Choi, Yejin Kim, Shin Hye Yoo, Sun Young Lee
Healthcare.2023; 11(13): 1939. CrossRef
Patient and hospital characteristics associated with do-not-resuscitate/do-not-intubate orders: a cross-sectional study based on the Taiwan stroke registry
Hsu-Ling Yeh, Fang-I Hsieh, Li-Ming Lien, Wen-Hua Kuo, Jiann-Shing Jeng, Yu Sun, Cheng-Yu Wei, Po-Yen Yeh, Hei-Tung Yip, Cheng-Li Lin, Nicole Huang, Kai-Cheng Hsu
BMC Palliative Care.2023;[Epub] CrossRef
Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea
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Cancer Research and Treatment.2022; 54(1): 20. CrossRef
Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement
Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Sang Ho Yoo, Younsuck Koh
The Korean Journal of Hospice and Palliative Care.2022; 25(1): 1. CrossRef
Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship
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Journal of Microbiology, Immunology and Infection.2022; 55(4): 651. CrossRef
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10,481 View
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31 Web of Science
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Separation of active chemical components against sarcoma 180 from stembark of catalpa ovata: Han Suk Yaung, Min Sun Kim, Hae Young Chung, Jae Sue Choi, Byung Woo Kim; J Korean Cancer Assoc. 1992;24(6):807-812.

Abstract PDF: No abstract available.

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Antimutagenic principle of artemisia iwayomogi Kit. and its action mechanism: Jae Min Bae, Min Sun Kim, Hee Jun Park, Hae Young Chung, Han Suk Yaung, Kun Young Park, Suk Hee Moon, Jae Soo Choi; J Korean Cancer Assoc. 1992;24(3):352-358.

Abstract PDF: No abstract available.

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