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Special Article
Life-Sustaining Treatment States in Korean Cancer Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment for Patients at the End of Life
Young-Woong Won, Hwa Jung Kim, Jung Hye Kwon, Ha Yeon Lee, Sun Kyung Baek, Yu Jung Kim, Do Yeun Kim, Hyewon Ryu
Cancer Res Treat. 2021;53(4):908-916.   Published online June 2, 2021
DOI: https://doi.org/10.4143/crt.2021.325
AbstractAbstract PDFPubReaderePub
Purpose
In Korea, the “Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life” was enacted on February 4, 2018. This study was conducted to analyze the current state of life-sustaining treatment decisions based on National Health Insurance Service (NHIS) data after the law came into force.
Materials and Methods
The data of 173,028 cancer deaths were extracted from NHIS qualification data between November 2015 and January 2019.
Results
The number of cancer deaths complied with the law process was 14,438 of 54,635 cases (26.4%). The rate of patient self-determination was 49.0%. The patients complying with the law process have used a hospice center more frequently (28% vs. 14%). However, the rate of intensive care unit (ICU) admission was similar between the patients who complied with and without the law process (ICU admission, 23% vs. 21%). There was no difference in the proportion of patients who had undergone mechanical ventilation and hemodialysis in the comparative analysis before and after the enforcement of the law and the analysis according to the compliance with the law. The patients who complied with the law process received cardiopulmonary resuscitation at a lower rate.
Conclusion
The law has positive effects on the rate of life-sustaining treatment decision by patient’s determination. However, there was no sufficient effect on the withholding or withdrawing of life-sustaining treatment, which could protect the patient from unnecessary or harmful interventions.

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 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
  • 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
  • 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
  • The Impact of Withdrawing or Withholding of Life-Sustaining Treatment: A Nationwide Case-Control Study Based on Medical Cost Analysis
    Claire Junga Kim, Do-Kyong Kim, Sookyeong Mun, Minkook Son
    Journal of Korean Medical Science.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
  • Differences in end-of-life care patterns between types of hospice used for cancer patients: a retrospective cohort study
    Il Yun, Eun-Cheol Park, Chung Mo Nam, Jaeyong Shin, Suk-Yong Jang, Sung-In Jang
    BMC Palliative Care.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
  • 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
  • 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
  • Healthcare resource utilization and medical costs in patients with terminal cancer during best supportive care
    Dong-Won Kang, Yoon-Bo Shim, Eui-Kyung Lee, Mi-Hai Park, Wen-Chi Chou
    PLOS ONE.2022; 17(6): e0269565.     CrossRef
  • Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea
    Jung Sun Kim, Sun Young Lee, Min Sung Lee, Shin Hye Yoo, Jeongmi Shin, Wonho Choi, Yejin Kim, Hyung Sook Han, Jinui Hong, Bhumsuk Keam, Dae Seog Heo
    BMC Palliative Care.2022;[Epub]     CrossRef
  • Effect of life-sustaining treatment decision law on pediatric in-hospital cardiopulmonary resuscitation rate: A Korean population-based study
    Jaeyoung Choi, Ah Young Choi, Esther Park, Meong Hi Son, Joongbum Cho
    Resuscitation.2022; 180: 38.     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
  • Willingness of patients with cancer pain to participate in end-of-life decisions: a multi-center cross-sectional study from three coastal provinces in southern China
    Xi Ke, Hongyu Zhu, Yu Zhang, Ling Yang, Simei Shi, Fang Zhu, Huiyu Luo
    BMC Palliative Care.2022;[Epub]     CrossRef
  • The Law Changes Behaviors: Is It Just Enough?
    Dae Ho Lee
    Cancer Research and Treatment.2021; 53(4): 895.     CrossRef
  • 6,107 View
  • 155 Download
  • 16 Web of Science
  • 16 Crossref
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Original Article
Patient’s Cognitive Function and Attitudes towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis
Dong Wook Shin, Juhee Cho, Debra L. Roter, So Young Kim, Jong Hyock Park, Hyung Kook Yang, Hyun Woo Lee, Sun-Seog Kweon, Yune Sik Kang, Keeho Park
Cancer Res Treat. 2018;50(3):681-690.   Published online July 4, 2017
DOI: https://doi.org/10.4143/crt.2017.201
AbstractAbstract PDFPubReaderePub
Purpose
Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences.
Materials and Methods
A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea andwere asked to express their preferences forfamily involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment).
Results
Both patients and family caregivers preferred greater family dominance in treatment decision makingwith the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted κ=0.32, κ=0.26, and κ=0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment.
Conclusion
Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.

Citations

Citations to this article as recorded by  
  • Comorbid Dementia and Cancer Therapy Decision-Making: A Scoping Review
    Sean N. Halpin, Gabriel Alain, Aaron Seaman, Erin E. Stevens, Hui Zhao, Mackenzie E. Fowler, Qiuyang Zhang, Tamara Cadet, Minzhi Ye, Jessica L. Krok-Schoen
    Journal of Applied Gerontology.2024; 43(8): 1132.     CrossRef
  • Assessing the association between quantity and quality of family caregiver participation in decision-making clinical encounters on patient activation in the metastatic breast cancer setting
    Nicole L. Henderson, Tanvi Padalkar, Garrett Bourne, Emma K. Hendrix, Courtney P. Williams, J. Nicholas Odom, Kristen Triebel, Gabrielle B. Rocque
    Supportive Care in Cancer.2024;[Epub]     CrossRef
  • Fatalism and metaphor in Confucianism: A qualitative study of barriers to genetic testing among first‐degree relatives of hereditary cancer patients from China
    Chaonan Jiang, Li Liu, Ye Wang, Liangzheng Wu, Wenxia Zhang, Xiaodan Wu
    Psycho-Oncology.2023; 32(2): 275.     CrossRef
  • The Role of Nurse on the Treatment Decision Support for Older People with Cancer: A Systematic Review
    Hiroko Komatsu, Yasuhiro Komatsu
    Healthcare.2023; 11(4): 546.     CrossRef
  • A prospective cohort study of decision‐making role preferences of patients with advanced cancer and their family caregivers
    Semra Ozdemir, Sean Ng, Isha Chaudhry, Chetna Malhotra, Eric Andrew Finkelstein
    Cancer.2023; 129(9): 1443.     CrossRef
  • Cancer literacy among Jordanian colorectal cancer survivors and informal carers: Qualitative explorations
    Samar J. Melhem, Shereen Nabhani-Gebara, Reem Kayyali
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Preferred and actual involvement of caregivers in oncologic treatment decision-making: A systematic review
    Laura M.L. Tielemans, Kirsten D. van Heugten, Marije E. Hamaker, Inez C. van Walree
    Journal of Geriatric Oncology.2023; 14(6): 101525.     CrossRef
  • Factors Affecting Patient and Caregiver Preferences for Treatment of Myeloma and Indolent Lymphoma
    Chia Jie Tan, Melinda Si Yun Tan, Chandramouli Nagarajan, Wee Joo Chng, Yen-Lin Chee, Melissa Ooi, Lawrence Cheng Kiat Ng, Yunxin Chen, Joanne Su Yin Yoong, Xin Yi Wong, Wei-Ying Jen
    JCO Oncology Practice.2023; 19(12): 1168.     CrossRef
  • The Association Between Mild Cognitive Impairment Diagnosis and Patient Treatment Preferences: a Survey of Older Adults
    Deborah A. Levine, Andrzej T. Galecki, Brenda L. Plassman, Angela Fagerlin, Lauren P. Wallner, Kenneth M. Langa, Rachael T. Whitney, Brahmajee K. Nallamothu, Lewis B. Morgenstern, Bailey K. Reale, Emilie M. Blair, Bruno Giordani, Kathleen Anne Welsh-Bohme
    Journal of General Internal Medicine.2022; 37(8): 1925.     CrossRef
  • Patient activation and treatment decision-making in the context of cancer: examining the contribution of informal caregivers’ involvement
    Chiara Acquati, Judith H. Hibbard, Ellen Miller-Sonet, Anao Zhang, Elena Ionescu
    Journal of Cancer Survivorship.2022; 16(5): 929.     CrossRef
  • Factors influencing family involvement in treatment decision-making for older patients with cancer: A scoping review
    Bea L. Dijkman, Marie Louise Luttik, Hanneke Van der Wal-Huisman, Wolter Paans, Barbara L. van Leeuwen
    Journal of Geriatric Oncology.2022; 13(4): 391.     CrossRef
  • The role of caregivers in the clinical pathway of patients newly diagnosed with breast and prostate cancer: A study protocol
    Clizia Cincidda, Serena Oliveri, Virginia Sanchini, Gabriella Pravettoni
    Frontiers in Psychology.2022;[Epub]     CrossRef
  • Treatment decision-making for older adults with cancer: A qualitative study
    Ni Gong, Qianqian Du, Hongyu Lou, Yiheng Zhang, Hengying Fang, Xueying Zhang, Xiaoyu Wu, Ya Meng, Meifen Zhang
    Nursing Ethics.2021; 28(2): 242.     CrossRef
  • Family Caregiving Situations and Engagement in Advance Care Planning
    Kyeongmo Kim, Michin Hong, Thomas Buckley
    Journal of Palliative Medicine.2020; 23(1): 125.     CrossRef
  • What We Talk about When We Talk about Caregiving: The Distribution of Roles in Cancer Patient Caregiving in a Family-Oriented Culture
    Ansuk Jeong, Dongwook Shin, Jong Hyock Park, Keeho Park
    Cancer Research and Treatment.2019; 51(1): 141.     CrossRef
  • Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey
    Dong Wook Shin, Keeho Park, Ansuk Jeong, Hyung Kook Yang, So Young Kim, Mihee Cho, Jong Hyock Park
    Journal of Geriatric Oncology.2019; 10(3): 459.     CrossRef
  • How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study
    J. Nicholas Dionne-Odom, Deborah Ejem, Rachel Wells, Amber E. Barnato, Richard A. Taylor, Gabrielle B. Rocque, Yasemin E. Turkman, Matthew Kenny, Nataliya V. Ivankova, Marie A. Bakitas, Michelle Y. Martin, Mojtaba Vaismoradi
    PLOS ONE.2019; 14(3): e0212967.     CrossRef
  • 10,773 View
  • 233 Download
  • 17 Web of Science
  • 17 Crossref
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