Completion rate of physician orders for life-sustaining treatment for patients with metastatic or recurrent cancer: a preliminary, cross-sectional study

BMC Palliative Care - Tập 18 Số 1 - 2019
Ju Won Kim1, Jung Yoon Choi1, Won Jin Jang1, Yoon Ji Choi1, Youn Seon Choi2, Sang Won Shin1, Yeul Hong Kim1, Kyong Hwa Park1
1Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, Seoul, South Korea
2Department of Family Medicine, Korea University Guro Hospital, Seoul, South Korea

Tóm tắt

Abstract Background “End of life” is a difficult topic of conversation in East Asian cultures, even among patients and doctors who share a good rapport. In 2016, the Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, which took the form of “Physician Orders for Life-Sustaining Treatment,” was introduced in South Korea. This study was conducted to investigate the completion rate of Physician Orders for Life-Sustaining Treatment in patients with advanced cancer on the active recommendation of physicians, as well as patients’ general attitudes toward end-of-life care. Methods We conducted a preliminary, cross-sectional descriptive survey on patients with advanced cancer. A total of 101 patients with advanced solid cancer agreed to participate in the study. The primary endpoint was the rate of completion of Physician Orders for Life-Sustaining Treatment based on a doctor’s suggestion. Written interviews were conducted to understand the perceptions and factors influencing patients’ decisions. Results Of the 101 patients, 72 (71.3%) agreed to prepare Physician Orders for Life-Sustaining Treatment. Patients who had an educational level of high school or higher were more likely to agree to complete Physician Orders for Life-Sustaining Treatment documentation as compared to the lower educational status group. More than half of the respondents who completed Physician Orders for Life-Sustaining Treatment documentation reported that they had more than a fair understanding of “life-sustaining care” or “Physician Orders for Life-Sustaining Treatment.” Participants’ reasons for Physician Orders for Life-Sustaining Treatment completion were diverse. Conclusions We found that highly educated patients, who understood the concept behind the policy well, tended to accept Physician Orders for Life-Sustaining Treatment without hesitation. Better education, information shared through the media, and conversations with health care providers might improve understanding of Physician Orders for Life-Sustaining Treatment in patients with cancer.

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Tài liệu tham khảo

Sang-Min Lee M, Su-Jung Kim M, Youn Seon Choi M, Dae Seog Heo M, Bo Moon Choi M, Daekyun Kim M, et al. Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment. J Korean Med Assoc. 2018;61(8):509–21.

Keam B, Yun YH, Heo DS, Park BW, Cho CH, Kim S, et al. The attitudes of Korean cancer patients, family caregivers, oncologists, and members of the general public toward advance directives. Support Care Cancer. 2013;21(5):1437–44.

McLaughlin LA, Braun KL. Asian and Pacific islander cultural values: considerations for health care decision making. Health Soc Work. 1998;23(2):116–26.

Alden DL, Friend J, Lee PY, Lee YK, Trevena L, Ng CJ, et al. Who decides: me or we? Family involvement in medical decision making in eastern and Western countries. Med Decis Mak. 2017;38(1):14–5.

Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, et al. CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Support Care Cancer. 2006;14(2):103–8.

Fujimoto K, Minami S, Yamamoto S, Ogata Y, Koba T, Futami S, et al. Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital. Support Care Cancer. 2014;22(6):1485–92.

Baek SK, Chang HJ, Byun JM, Han JJ, Heo DS. The association between end-of-life care and the time interval between provision of a do-not-resuscitate consent and death in cancer patients in Korea. Cancer Res Treat. 2017;49(2):502.

Kwon I, Koh Y, Yun Y, Heo D, Seo S, Kim H, et al. A study of the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients in Korea. Korean J Med Ethics. 2010;13(1):1–16.

Glick HR. The right-to-die: state policymaking and the elderly. J Aging Stud. 1991;5(3):283–307.

US SC. Cruzan V. Director, Missouri Department of Health. West’s Supreme Court reporter. 1990;110:2841.

Brown BA. The history of advance directives a literature review. J Gerontol Nurs. 2003;29(9):4–9.

Greco PJ, Schulman KA, Lavizzo-Mourey R, Hansen-Flaschen J. The patient self-determination act and the future of advance directives. Ann Intern Med. 1991;115(8):639–43.

Annas GJ. When procedures limit rights: from Quinlan to Conroy. Hast Cent Rep. 1985;15(2):24–6.

Ahn K, Bae H. Reflections on the movement for the legalization of death with dignity as withdrawal of futile life-sustaining treatment in South Korea. J Korean L. 2010;10:43.

Kim S, Cho B. A study of familism and family support for the aged. J Korean Home Manag Assoc. 1991;9(2):303–22.

Jacobs D. Low public expenditures on social welfare: do east Asian countries have a secret? Int J Soc Welf. 2000;9(1):2–16.

Knight BG, Robinson GS, Longmire CVF, Chun M, Nakao K, Kim JH. Cross cultural issues in caregiving for persons with dementia: do familism values reduce burden and distress? Ageing Int. 2002;27(3):70–94.

Rhee KO, Lee MJ. A study on caregiving burden among family caregivers of impaired elderly. Journal of Korea Gerontological Society. 2000;20(2):215–28.

Sudore RL, Fried TR. Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010;153(4):256–61.

Emanuel LL, Danis M, Pearlman RA, Singer PA. Advance care planning as a process: structuring the discussions in practice. J Am Geriatr Soc. 1995;43(4):440–6.

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BMC Palliative Care

Tập 18 Số 1

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