Cancer Research and Treatment

Special Article

Preparation and Practice of the Necessary Documents in Hospital for the “Act on Decision of Life-Sustaining Treatment for Patients at the End-of-Life”: Sun Kyung Baek, Hwa Jung Kim, Jung Hye Kwon, Ha Yeon Lee, Young-Woong Won, Yu Jung Kim, Sujin Baik, Hyewon Ryu; Cancer Res Treat. 2021;53(4):926-934. Published online June 2, 2021; DOI: https://doi.org/10.4143/crt.2021.326

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Purpose
Six forms relating to decisions on life-sustaining treatment (LST) for patients at the end-of-life (EOL) in hospital are required by the “Act on Decision of LST for Patients at the EOL.” We investigated the preparation and creation status of these documents from the database of the National Agency for Management of LST.
Materials and Methods
We analyzed the contents and details of each document necessary for decisions on LST, and the creation status of forms. We defined patients completing form 1 as “self-determined” of LST, and those whose family members had completed form 11/12 as “family decision” of LST. According to the determination subject, we compared the four items of LST on form 13 (the paper of implementation of LST) and the documentation time interval between forms.
Results
The six forms require information about the patient, doctor, specialized doctor, family members, institution, decision for LST, and intention to use hospice services. Of 44,381 who had completed at least one document, 36,693 patients had form 13. Among them, 11,531, 10,976, and 12,551 people completed forms 1, 11, and 12, respectively. The documentation time interval from forms 1, 11, or 12 to form 13 was 8.6±13.6 days, 1.0±9.5 days, and 1.5±9.7 days, respectively.
Conclusion
The self-determination rate of LST was 31% and the mean time interval from self-determination to implementation of LST was 8.6 days. The creation of these forms still takes place when the patients are close to death.

Citations

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Soyou Park, Soo-Young Yu
Supportive Care in Cancer.2026;[Epub] CrossRef
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Sang-Ho Yoo
Journal of the Korean Medical Association.2026; 69(7): 577. CrossRef
Orden de no reanimar en pacientes oncológicos en la UCI
Gustavo Batista Ferro, Carlos Arthur da Silva Morais, Erick Antonio Rodrigues Mendes, Francinei Gomes Pinto, Marcelo Gaia Epifane, Ana Cristina Vidigal Soeiro
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Gustavo Batista Ferro, Carlos Arthur da Silva Morais, Erick Antonio Rodrigues Mendes, Francinei Gomes Pinto, Marcelo Gaia Epifane, Ana Cristina Vidigal Soeiro
Revista Bioética.2025;[Epub] CrossRef
Ordem de não reanimação em pacientes oncológicos na UTI
Gustavo Batista Ferro, Carlos Arthur da Silva Morais, Erick Antonio Rodrigues Mendes, Francinei Gomes Pinto, Marcelo Gaia Epifane, Ana Cristina Vidigal Soeiro
Revista Bioética.2025;[Epub] CrossRef
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Yu Jung Kim, Sun-Hyun Kim
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Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship
Dayeong Kim, Subin Kim, Kyoung Hwa Lee, Sang Hoon Han
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Dae Ho Lee
Cancer Research and Treatment.2021; 53(4): 895. CrossRef

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Original Articles

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

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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.

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Awareness, attitudes, and educational needs regarding the life-sustaining treatment decision-making act in Korea among healthcare providers and medical students: a comparative analysis
Jooseon Lee, So-yun Kim, Duk-ki Kim, Green Hong, Song I Lee
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Rédaction d’un modèle de directives anticipées approprié pour les femmes atteintes d’un cancer du sein : méthode Delphi
Bernard Frèche, Axelle Martinet, Yaritza Carneiro, Marc Besnier, Élodie Poupin
Santé Publique.2026; vol. 38(2): 203. CrossRef
Shared decision-making with family involvement in Korean healthcare: a narrative review
Sang-Ho Yoo
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Sangmin Lee, Naixue Cui, Hyejin Kim
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Supakorn Sripaew, Jennifer Philip, Anna Collins, Pawita Limsomwong, Jennifer Weil, Rungarun Kittichest, Polathep Vichitkunakorn, Sawitri Assanangkornchai
BMC Palliative Care.2025;[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
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Boram Kim, Junyong Lee, Youn Seon Choi
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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
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Il Yun, Hyunkyu Kim, Eun-Cheol Park, Suk-Yong Jang
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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

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Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients: Ji Hyung Hong, Sang-Young Rho, Young Seon Hong; Cancer Res Treat. 2013;45(4):270-275. Published online December 31, 2013; DOI: https://doi.org/10.4143/crt.2013.45.4.270

Abstract PDF PubReader ePub

PURPOSE
It is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients. This study describes the treatment patterns and end-of-life care in terminal gastric cancer patients.
MATERIALS AND METHODS
We retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded interval between last chemotherapy dose and death; frequency of emergency room visits or admission to the intensive care unit in the last month before death; rate of hospice referral and agreement with written do-not-resuscitate orders; and change in laboratory values in the last three months before death.
RESULTS
During the last six months of life, 130 patients (94.9%) received palliative chemotherapy; 86 (62.7%) during the final two months; 41 (29.9%) during the final month. During the final month, 53 patients (38.7%) visited an emergency room more than once; 21 (15.3%) were admitted to the intensive care unit. Hospice referral occurred in 54% (74 patients) of the patients; 93.4% (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly two weeks before death; total bilirubin, one month before; and C-reactive protein, between four and two weeks before death.
CONCLUSION
Our results demonstrated that a significant proportion of gastric cancer patients received palliative chemotherapy to the end of life and the patients who stopped the chemotherapy at least one month before death had a lower rate of intensive care unit admission and longer overall survival than those who sustained aggressive chemotherapy until the last months of their lives.

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