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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2021.131    [Accepted]
Analysis of Cancer Patient Decision-making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea
Dalyong Kim1, Shin Hye Yoo2, Seyoung Seo3, Hyun Jung Lee1, Min Sun Kim4, Sung Joon Shin1, Chi-Yeon Lim5, Do Yeun Kim1, Dae Seog Heo2,6, Chae-Man Lim7
1Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
2Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
3Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
4Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
5Department of Biostatistics, Dongguk University College of Medicine, Goyang, Korea
6Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
7Department of Pulmonary and Critical Care Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence  Do Yeun Kim ,Tel: 82-31-961-7143, Fax: 82-31-961-7141, Email: smdkdy@hanmail.net
Chae-Man Lim ,Tel: 82-2-3010-3135, Fax: 82-2-3010-4709, Email: cmlim@amc.seoul.kr
Received: January 26, 2021;  Accepted: April 9, 2021.  Published online: April 12, 2021.
ABSTRACT
Purpose
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 Methods
Of 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.
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.
Key words: Terminally ill, Life support care, Neoplasms
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