End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience원문보기
Jin, Sol
(Department of Internal medicine, Kosin University Gospel Hospital)
,
Kim, Jehun
(Department of Pulmonology, Kosin University Gospel Hospital)
,
Lee, Jin Young
(Department of Infectious disease, Kosin University Gospel Hospital)
,
Ko, Taek Yong
(Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital)
,
Oh, Gyu Man
(Department of Internal medicine, Kosin University Gospel Hospital)
Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary car...
Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.
Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.
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문제 정의
In this study evaluating the limitations of the Act on Decisions on Life-Sustaining Treatment and ways to address those limitations, we investigated the informed consent forms completed within a year after the Act on Decision on Life-Sustaining Treatment was implemented, and compared and analyzed the diseases encompassed by the law, the types of informed consent, differences between cancer and non-cancer patients, and whether the patient’s intentions were reflected when the consent form was completed. Based on this analysis, this study discusses the supplemental steps necessary to promote patient-centered self-determination in lifesustaining treatment decisions.
This study was conducted to investigate the actual conditions and to address relevant limitations after the implementation of the Act on Decisions on Life-Sustaining Treatment for patients at a single medical institution. In this study evaluating the limitations of the Act on Decisions on Life-Sustaining Treatment and ways to address those limitations, we investigated the informed consent forms completed within a year after the Act on Decision on Life-Sustaining Treatment was implemented, and compared and analyzed the diseases encompassed by the law, the types of informed consent, differences between cancer and non-cancer patients, and whether the patient’s intentions were reflected when the consent form was completed.
제안 방법
From patients’ medical records, information was extracted on sex, age, where the life-sustaining treatment plan was written, whether or not the patient died, the length of the hospital stay, when the life-sustaining treatment document was written, the period from the completion of the document to death, the type of the document that was written, the content of the document, underlying diseases that led to death, and special life-sustaining treatments such as inotropics, CPR, mechanical ventilation, high-flow nasal cannula therapy, and dialysis.
In this study evaluating the limitations of the Act on Decisions on Life-Sustaining Treatment and ways to address those limitations, we investigated the informed consent forms completed within a year after the Act on Decision on Life-Sustaining Treatment was implemented, and compared and analyzed the diseases encompassed by the law, the types of informed consent, differences between cancer and non-cancer patients, and whether the patient’s intentions were reflected when the consent form was completed.
The purpose of this study was to determine which patients used the Act on Decisions on Life-Sustaining Treatment in actual medical care, and how and when they did so, by analyzing their clinical characteristics and features of the written life-sustaining treatment decisions made by patients who have decided to withdraw life-sustaining treatment at a single tertiary hospital after the implementation of the system for life-sustaining treatment decisions. The most important aspect of the current system of making life-sustaining treatment decisions is that it provides a framework for withdrawing life-sustaining treatment based on the patient’s intentions, as expressed by the patient himself or herself at the time of the decision.
대상 데이터
Patients with malignant tumors (cancer patients) and other diseases (non-cancer patients) were compared and analyzed. There were 231 cancer patients and 103 non-cancer patients. The mean age of the cancer patients was 65.
This study conducted a retrospective analysis of the medical records of patients who had provided written informed consent for life-sustaining treatment decisions from February 1, 2018 to August 1, 2018 at a tertiary university hospital in Busan.
이론/모형
SPSS version 24 (IBM Corp, Armonk, NY, USA) was used for statistical analysis. The Mann-Whitney U test was used to evaluate statistical significance in comparative analyses of continuous variables, and the chi-square test and the Fisher exact test were used for nominal variables.
성능/효과
[4] compared and analyzed the intensity of end-oflife treatment at a single institution, and the degree of special life-sustaining treatment was found to be significantly lower in cancer patients than in non-cancer patients; furthermore, non-cancer patients provided informed consent to withdraw life-sustaining treatment when death was more imminent [4]. In this study, non-cancer patients had longer intervals from hospitalization to life-sustaining treatment decisions and from the decision to discontinue life-sustaining treatment than cancer patients, but the difference was not statistically significant. This may have been due to the fact that this study was conducted among patients who provided consent to discontinue life-sustaining treatment during hospitalization and excluded outpatients who provided consent, as those patients would be expected to have a relatively long survival time.
참고문헌 (9)
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