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3 "Hospice care"
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Palliative medicine
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 Res Treat. 2025;57(1):280-288.   Published online July 1, 2024
DOI: https://doi.org/10.4143/crt.2024.360
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
In Korea, the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment (LST) was implemented on February 4, 2018. We aimed to investigate relevant factors and clinical changes associated with LST decisions after law enforcement.
Materials and Methods
This single-center retrospective study included patients who completed LST documents using legal forms at Asan Medical Center from February 5, 2018, to June 30, 2020.
Results
5,896 patients completed LST documents, of which 2,704 (45.8%) signed the documents in person, while family members of 3,192 (54%) wrote the documents on behalf of the patients. Comparing first year and following year of implementation of the act, the self-documentation rate increased (43.9% to 47.2%, p=0.014). Moreover, the number of LST decisions made during or after intensive care unit admission decreased (37.8% vs. 35.2%, p=0.045), and the completion rate of LST documents during chemotherapy increased (6.6% vs. 8.9%, p=0.001). In multivariate analysis, age < 65 (odds ratio [OR], 1.724; 95% confidence interval [CI], 1.538 to 1.933; p < 0.001), unmarried status (OR, 1.309; 95% CI, 1.097 to 1.561; p=0.003), palliative care consultation (OR, 1.538; 95% CI, 1.340 to 1.765; p < 0.001), malignancy (OR, 1.864; 95% CI, 1.628 to 2.133; p < 0.001), and changes in timing on the first year versus following year (OR, 1.124; 95% CI, 1.003 to 1.260; p=0.045) were related to a higher self-documentation rate.
Conclusion
Age < 65 years, unmarried status, malignancy, and referral to a palliative care team were associated with patients making LST decisions themselves. Furthermore, the subject and timing of LST decisions have changed with the LST act.
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The Effect of Hospice Consultation on Aggressive Treatment of Lung Cancer
Shin Hye Yoo, Bhumsuk Keam, Miso Kim, Tae Min Kim, Dong-Wan Kim, Dae Seog Heo
Cancer Res Treat. 2018;50(3):720-728.   Published online July 14, 2017
DOI: https://doi.org/10.4143/crt.2017.169
AbstractAbstract PDFPubReaderePub
Purpose
The aims of this study were to investigate trends of aggressive treatment of non-small cell lung cancer (NSCLC) patients at the end-of-life (EOL) during the recent 5 years and examine the relationship between hospice consultation (HC) and aggressive care.
Materials and Methods
The medical records of 789 patients with stage IIIB-IV NSCLC at Seoul National University Hospital (SNUH) who received palliative chemotherapy and died from 2010 to 2014 were retrospectively reviewed. Indicators of aggressive treatment were evaluated, and the association of HC with these indicators was analyzed.
Results
During the last 5 years, the frequency of HC increased from 26.7% to 43.6%. The time interval from last chemotherapy to death increased, and the proportion of patients who received palliative chemotherapy, visited an emergency room, were admitted to intensive care unit, during the last month of life, and died in SNUH significantly decreased over time. Referral to HC was significantly associated with lower intensive care unit admission rates, lower out-of-hospital death rates, and less use of the chemotherapy within 1 month prior to death. Overall survival did not differ by HC.
Conclusion
The pattern of cancer care nearthe EOL has become less aggressivewhen HCwas provided. The positive association of HCwith better EOL care suggests that providing HC at the optimal time might help to avoid futile aggressive treatment.

Citations

Citations to this article as recorded by  
  • Hospice delivery models and survival differences in the terminally ill: a large cohort study
    Wei-Shu Lai, I-Ting Liu, Jui-Hung Tsai, Pei-Fang Su, Pin-Hsuan Chiu, Ying-Tzu Huang, Ge-Lin Chiu, Yu-Yeh Chen, Peng-Chan Lin
    BMJ Supportive & Palliative Care.2024; 14(e1): e1134.     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
  • Antibiotic prescription patterns during last days of hospitalized patients with advanced cancer: the role of palliative care consultation
    Jeong-Han Kim, Shin Hye Yoo, Bhumsuk Keam, Dae Seog Heo
    Journal of Antimicrobial Chemotherapy.2023; 78(7): 1694.     CrossRef
  • Discussing POLST-facilitated hospice care enrollment in patients with terminal cancer
    Ho Jung An, Hyun Jeong Jeon, Sang Hoon Chun, Hyun Ae Jung, Hee Kyung Ahn, Kyung Hee Lee, Min-ho Kim, Ju Hee Kim, Jaekyung Cheon, Su-Jin Koh
    Supportive Care in Cancer.2022; 30(9): 7431.     CrossRef
  • Perceptions on the current content and pedagogical approaches used in end-of-life care education among undergraduate nursing students: a qualitative, descriptive study
    Wenjing Cao, Chunyan Li, Qianqian Zhang, Huiru Tong
    BMC Medical Education.2022;[Epub]     CrossRef
  • Increased in-hospital mortality and emergent cases in patients with stage IV cancer
    Elleana J. Majdinasab, Yana Puckett, Kevin Y. Pei
    Supportive Care in Cancer.2021; 29(6): 3201.     CrossRef
  • Changes of End of Life Practices for Cancer Patients and Their Association with Hospice Palliative Care Referral over 2009-2014: A Single Institution Study
    Hyun Jung Jho, Eun Jung Nam, Il Won Shin, Sun Young Kim
    Cancer Research and Treatment.2020; 52(2): 419.     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 Research and Treatment.2020; 52(3): 917.     CrossRef
  • Do advance directive attitudes and perceived susceptibility and end-of-life life-sustaining treatment preferences between patients with heart failure and cancer differ?
    JinShil Kim, Jiin Choi, Mi-Seung Shin, Miyeong Kim, EunJu Seo, Minjeong An, Jae Lan Shim, Seongkum Heo, Hans-Peter Brunner-La Rocca
    PLOS ONE.2020; 15(9): e0238567.     CrossRef
  • Duration of palliative care before death in international routine practice: a systematic review and meta-analysis
    Roberta I. Jordan, Matthew J. Allsop, Yousuf ElMokhallalati, Catriona E. Jackson, Helen L. Edwards, Emma J. Chapman, Luc Deliens, Michael I. Bennett
    BMC Medicine.2020;[Epub]     CrossRef
  • Relationship Between Preferences for Advance Directive Treatments and Decisional Conflicts Among Low-Income, Home-Based Cancer Management Recipients in Korea
    Miyeong Kim, Seongkum Heo, Jung-Yi Hur, JaeLan Shim, JinShil Kim
    Journal of Transcultural Nursing.2019; 30(6): 587.     CrossRef
  • Factors associated with early mortality in non-small cell lung cancer patients following systemic anti-cancer therapy: A 10 year population-based study
    Amanda J.W. Gibson, Haocheng Li, Adrijana D’Silva, Anifat A. Elegbede, Roxana A. Tudor, Shannon Otsuka, D. Gwyn Bebb, Winson Y. Cheung
    Lung Cancer.2019; 134: 141.     CrossRef
  • Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review
    Nauzley C Abedini, Rachel K Hechtman, Achintya D Singh, Rafina Khateeb, Jason Mann, Whitney Townsend, Vineet Chopra
    The Lancet Oncology.2019; 20(11): e627.     CrossRef
  • Demographic and Socioeconomic Factors for Renouncing Further Active Therapy for Patients with Brain Metastasis of Non-Small Cell Lung Cancer
    Gyuseo Jung, Seok-Hyun Kim, Tae Gyu Kim, Young Zoon Kim
    Brain Tumor Research and Treatment.2019; 7(2): 112.     CrossRef
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  • 16 Web of Science
  • 14 Crossref
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Patient’s Factors at Entering Hospice Affecting Length of Survival in a Hospice Center
Guk Jin Lee, Hye Shin Ahn, Se Eun Go, Ji Hyun Kim, Min Wu Seo, Seung Hun Kang, Yeo Ree Yang, Mi Yeong Lee, Ku Ock Lee, Sang Hoon Chun, Jong Youl Jin
Cancer Res Treat. 2015;47(1):1-8.   Published online August 28, 2014
DOI: https://doi.org/10.4143/crt.2013.148
AbstractAbstract PDFPubReaderePub
Purpose
In order to provide effective hospice care, adequate length of survival (LOS) in hospice is necessary. However the reported average LOS is much shorter. Analysis of LOS in hospice has not been reported from Korea. We evaluated the duration of LOS and the factors associated with LOS at our hospice center.
Materials and Methods
We retrospectively examined 446 patients who were admitted to our hospice unit between January 2010 and December 2012. We performed univariate and multivariate analysis for analysis of factors associated with LOS.
Results
The median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%) was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completely bedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients (30.1%) had decreased consciousness, from confusion to coma. The median time interval between the day of the last anticancer treatment and the day of hospice admission was 75 days. By analysis of the results of multivariate analysis, decreased intake and laboratory results showing increased total white blood cell (WBC), decreased platelet count, increased serum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival in hospice.
Conclusion
Before hospice admission, careful evaluation of the patient’s performance, particularly the oral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, because these were strong predictors of shorter LOS. In the future, conduct of prospective controlled studies is warranted in order to confirm the relationship between potential prognostic factors and LOS in hospice.

Citations

Citations to this article as recorded by  
  • Changes in the palliative performance scale may be as important as the initial palliative performance scale for predicting survival in terminal cancer patients
    Guk Jin Lee, Ji Hyun Gwak, Myoung Sim Kim, Mi Yeong Lee, Seo Ree Kim, Sang Hoon Chun, Jong Youl Jin
    Palliative and Supportive Care.2021; 19(5): 547.     CrossRef
  • Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study
    Eun Ju Park, Kwonoh Park, Jae-Joon Kim, Sang-Bo Oh, Ki Sun Jung, So Yeon Oh, Yun Jeong Hong, Jin Hyeok Kim, Joo Yeon Jang, Ung-Bae Jeon
    Cancer Research and Treatment.2021; 53(3): 881.     CrossRef
  • Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study
    Min-Seok Seo, In Cheol Hwang, Jaehun Jung, Hwanhee Lee, Jae Hee Choi, Jae-Yong Shim
    BMC Palliative Care.2020;[Epub]     CrossRef
  • The Impact of Combined Use of Opioids, Antipsychotics, and Anxiolytics on Survival in the Hospice Setting
    Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Aleksandar Čubranić
    Journal of Pain and Symptom Management.2018; 55(1): 22.     CrossRef
  • Cancer-related hypercalcemia in oral cancer
    T.-C. Lin, K.-L. Liang, L.-C. Lee, C.-Y. Hsu, T.-T. Yen
    International Journal of Oral and Maxillofacial Surgery.2018; 47(6): 685.     CrossRef
  • Physical Exercise: An Evaluation of a New Clinical Biomarker of Survival in Hospice Patients
    Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Lidija Gović-Golčić, Aleksandar Čubranić
    American Journal of Hospice and Palliative Medicine®.2018; 35(11): 1377.     CrossRef
  • Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea
    Youngin Lee, Seung Hun Lee, Yun Jin Kim, Sang Yeoup Lee, Jeong Gyu Lee, Dong Wook Jeong, Yu Hyeon Yi, Young Jin Tak, Hye Rim Hwang, Mieun Gwon
    BMC Palliative Care.2018;[Epub]     CrossRef
  • Prediction of Patient Discharge Status Based on Indicators on Admission
    Sung-In Chung, Seung Hun Lee, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Yu-Hyeon Yi, Young-Hye Cho, Young-Jin Tak, Hye-Rim Hwang, Eun-Ju Park, Kyung-Mi Kim
    The Korean Journal of Hospice and Palliative Care.2018; 21(3): 75.     CrossRef
  • Amyotrophic Lateral Sclerosis Survival Score (ALS-SS): A simple scoring system for early prediction of patient survival
    Christian Lunetta, Andrea Lizio, Mario Giovanni Melazzini, Eleonora Maestri, Valeria A. Sansone
    Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration.2016; 17(1-2): 93.     CrossRef
  • Safety, efficacy, and patient-perceived satisfaction of peripherally inserted central catheters in terminally ill cancer patients: a prospective multicenter observational study
    Kwonoh Park, Hyun Jung Jun, So Yeon Oh
    Supportive Care in Cancer.2016; 24(12): 4987.     CrossRef
  • 12,363 View
  • 79 Download
  • 9 Web of Science
  • 10 Crossref
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