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The Situation of Life-Sustaining Treatment One Year after Enforcement of the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life in Korea: Data of National Agency for Management of Life-Sustaining Treatment
Ha Yeon Lee, Hwa Jung Kim, Jung Hye Kwon, Sun Kyung Baek, Young-Woong Won, Yu Jung Kim, Su Jin Baik, Hyewon Ryu
Cancer Res Treat. 2021;53(4):897-907.   Published online June 2, 2021
DOI: https://doi.org/10.4143/crt.2021.327
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life” was enacted on February 3, 2016 and went into effect on February 4, 2018 in Korea. This study reviewed the first year of determination to life-sustaining treatment (LST) through data analysis of the National Agency for Management of Life-Sustaining Treatment.
Materials and Methods
The National Agency for Management of LST provided data between February 4, 2018 and January 31, 2019 anonymously from 33,549 patients. According to the forms patients were defined as either elf-determinants or family-determinants.
Results
The median age of the patient was 73 and the majority was male (59.9%). Cancer patients were 59% and self-determinants were 32.1%. Cancer patients had a higher rate of self-determinants than non-cancer (47.3% vs. 10.1%). Plan for hospice service was high in cancer patients among self-determinants (81.0% vs. 37.5%, p < 0.001). In comparison to family-determinants, self-determinants were younger (median age, 67 years vs. 75 years; p < 0.001) and had more cancer diagnosis (87.1% vs. 45.9%, p < 0.001). Decision of withholding or withdrawing of LSTs in cancer patients was higher than non-cancer patients in four items.
Conclusion
Cancer patients had a higher rate in self-determination and withholding or withdrawing of LSTs than non-cancer patients. Continued revision of the law and education of the public will be able to promote withdrawing or withholding the futile LSTs in patients at end-of-life. Further study following the revision of the law should be evaluated to change of end-of-life care.

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
  • Issues and implications of the life-sustaining treatment decision act: comparing the data from the survey and clinical data of inpatients at the end-of-life process
    Eunjeong Song, Dongsoon Shin, Jooseon Lee, Seonyoung Yun, Minjeong Eom, Suhee Oh, Heejung Lee, Jiwan Lee, Rhayun Song
    BMC Medical Ethics.2024;[Epub]     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
  • Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study
    Min Seol Jang, Shin Hye Yoo, Min Sun Kim, Belong Cho, Kyae Hyung Kim, Jeongmi Shin, Inyoung Hwang, Seok-Jin Choi, Jung-Joon Sung, Sun Young Lee
    Journal of Clinical Neurology.2024; 20(2): 166.     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
  • Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department
    Ho Sub Chung, Yunhyung Choi, Ji Yeon Lim, Keon Kim, Sung Jin Bae, Yoon Hee Choi, Dong Hoon Lee
    Medicina.2024; 60(6): 955.     CrossRef
  • Beyond Legal Boundaries: Public and Clinician Perspectives on Treatment Withdrawal in Infants With Poor Neurological Prognosis
    In Gyu Song, Jung Lee, Min Sun Kim, Ji Weon Lee, So Yeon Jeon, Shin Hye Yoo, Hye Yoon Park
    Journal of Korean Medical Science.2024;[Epub]     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
  • Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
    Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
    BMC Medical Ethics.2023;[Epub]     CrossRef
  • Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement
    Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Sang Ho Yoo, Younsuck Koh
    The Korean Journal of Hospice and Palliative Care.2022; 25(1): 1.     CrossRef
  • Hospice-Palliative Medicine as a Model of Value-Based Healthcare
    Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Keunjoo Yoo, Insun Choi, Min-Jeong Kim
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
  • Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?
    In-Ae Song
    Acute and Critical Care.2022; 37(2): 256.     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
  • Hospice Care Preferences and Its Associated Factors among Community-Dwelling Residents in China
    Huijing Lin, Eunjeong Ko, Bei Wu, Ping Ni
    International Journal of Environmental Research and Public Health.2022; 19(15): 9197.     CrossRef
  • Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study
    Jeongmi Shin, Yejin Kim, Shin Hye Yoo, Jin-Ah Sim, Bhumsuk Keam
    The Korean Journal of Hospice and Palliative Care.2022; 25(4): 150.     CrossRef
  • The Law Changes Behaviors: Is It Just Enough?
    Dae Ho Lee
    Cancer Research and Treatment.2021; 53(4): 895.     CrossRef
  • 8,055 View
  • 211 Download
  • 15 Web of Science
  • 16 Crossref
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Original Article
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 Res Treat. 2020;52(3):917-924.   Published online March 23, 2020
DOI: https://doi.org/10.4143/crt.2019.740
AbstractAbstract PDFPubReaderePub
Purpose
Life-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. Itremains unclear whether the act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement.
Materials and Methods
Retrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn.
Results
Of 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82)withdrew it. We found a higher withdrawal rate when family members made the decisions (13.3% vs. 1.7%, p < 0.001).
Conclusion
After the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.

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
  • Development of Public Health Center‐Based Culturally Tailored Hypertension Self‐Care Intervention Among Adults in Rural Ghana
    Kennedy Diema Konlan, Hyeonkyeong Lee, Yeonsoo Jang, Seung Eun Lee, Soyoon Kim
    Public Health Nursing.2025;[Epub]     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
  • 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
  • Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
    Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
    Acute and Critical Care.2024; 39(2): 294.     CrossRef
  • End-of-life care in the intensive care unit: the optimal process of decision to withdrawing life-sustaining treatment based on the Korean medical environment and culture
    Ho Jin Yong, Dohhyung Kim
    Acute and Critical Care.2024; 39(2): 321.     CrossRef
  • Inpatient Hospice Care in Korea during the COVID-19 Pandemic: A Preliminary Study
    Youn Seon Choi, Sun Wook Hwang, In Cheol Hwang
    Journal of Hospice and Palliative Care.2024; 27(2): 82.     CrossRef
  • Issues and implications of the life-sustaining treatment decision act: comparing the data from the survey and clinical data of inpatients at the end-of-life process
    Eunjeong Song, Dongsoon Shin, Jooseon Lee, Seonyoung Yun, Minjeong Eom, Suhee Oh, Heejung Lee, Jiwan Lee, Rhayun Song
    BMC Medical Ethics.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
  • Modification of termination of resuscitation rule with compression time interval in South Korea
    Song Yi Park, Daesung Lim, Ji Ho Ryu, Yong Hwan Kim, Byungho Choi, Sun Hyu 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
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    Jae Eun Jang, Jeong Moon Ryu, Min Hee Heo, Do Eun Kwon, Ji Yeon Seo, Dong Yeon Kim
    The Korean Journal of Hospice and Palliative Care.2023; 26(2): 69.     CrossRef
  • Advance Care Planning in South Korea
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    Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68.     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
  • Patient and hospital characteristics associated with do-not-resuscitate/do-not-intubate orders: a cross-sectional study based on the Taiwan stroke registry
    Hsu-Ling Yeh, Fang-I Hsieh, Li-Ming Lien, Wen-Hua Kuo, Jiann-Shing Jeng, Yu Sun, Cheng-Yu Wei, Po-Yen Yeh, Hei-Tung Yip, Cheng-Li Lin, Nicole Huang, Kai-Cheng Hsu
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  • Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea
    Dalyong Kim, Shin Hye Yoo, Seyoung Seo, Hyun Jung Lee, Min Sun Kim, Sung Joon Shin, Chi-Yeon Lim, Do Yeun Kim, Dae Seog Heo, Chae-Man Lim
    Cancer Research and Treatment.2022; 54(1): 20.     CrossRef
  • Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement
    Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Sang Ho Yoo, Younsuck Koh
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  • Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?
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    Acute and Critical Care.2022; 37(2): 256.     CrossRef
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    Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
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  • Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea
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    BMC Palliative Care.2022;[Epub]     CrossRef
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    Journal of the American Medical Directors Association.2022; 23(10): 1634.     CrossRef
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  • The Situation of Life-Sustaining Treatment One Year after Enforcement of the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life in Korea: Data of National Agency for Management of Life-Sustaining Treatment
    Ha Yeon Lee, Hwa Jung Kim, Jung Hye Kwon, Sun Kyung Baek, Young-Woong Won, Yu Jung Kim, Su Jin Baik, Hyewon Ryu
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  • 10,134 View
  • 237 Download
  • 31 Web of Science
  • 33 Crossref
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