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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
  • 8,056 View
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  • 15 Web of Science
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Current Status and Cardinal Features of Patient Autonomy after Enactment of the Life-Sustaining Treatment Decisions Act in Korea
Hwa Jung Kim, Yu Jung Kim, Jung Hye Kwon, Young-Woong Won, Ha Yeon Lee, Sun Kyung Baek, Hyewon Ryu, Do Yeun Kim
Cancer Res Treat. 2021;53(4):917-925.   Published online June 2, 2021
DOI: https://doi.org/10.4143/crt.2021.324
AbstractAbstract PDFPubReaderePub
Purpose
The main purpose of the Life-Sustaining Treatment Decisions Act recently enacted in Korea is to respect the patient’s self-determination. We aimed to investigate the current status and features of patient self-determination after implementation of the law.
Materials and Methods
Between February 2018 and January 2019, 54,635 cancer deaths were identified from the National Health Insurance Service (NHIS) database. We analyzed the characteristics of decedents who complied with the law process by self-determination compared with decedents with family determination and with decedents who did not comply with the law process.
Results
In multivariable analysis, patients with self-determination were younger, were less likely to live in rural areas, were less likely to belong to the highest income quintile, were less likely to be treated in general hospitals, and were more likely to show a longer time from cancer diagnosis compared with patients with family determination. Compared with patients who did not comply with the law process, patients with self-determination were younger, lived in Seoul or capital area, were less likely to belong to the highest income quintile, were treated in general hospitals, were less likely to have genitourinary or hematologic malignancies, scored higher on the Charlson comorbidity index, and showed a longer time from cancer diagnosis. Patients with self-determination were more likely to use hospice and less likely to use intensive care units (ICUs) at the end-of-life (EOL).
Conclusion
Decedents with self-determination were more likely to be younger, reside in the Seoul or capital area, show a longer time from cancer diagnosis, and were less likely to belong to the highest income quintile. They utilized hospice more frequently, and received less ICU care at the EOL.

Citations

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  • The effects of hospice care on healthcare expenditure among cancer patients
    Hoyol Jhang, Wonjeong Jeong, Hyun-Soo Zhang, Dong-Woo Choi, Hyejung Kang, Sohee Park
    BMC Health Services Research.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
  • 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
  • Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship
    Dayeong Kim, Subin Kim, Kyoung Hwa Lee, Sang Hoon Han
    Journal of Microbiology, Immunology and Infection.2022; 55(4): 651.     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
  • The Law Changes Behaviors: Is It Just Enough?
    Dae Ho Lee
    Cancer Research and Treatment.2021; 53(4): 895.     CrossRef
  • 6,258 View
  • 134 Download
  • 4 Web of Science
  • 6 Crossref
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Original Articles
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
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    Sun Young Lee, Young Sun Ro, Sang Do Shin, Eunsil Ko, Seong Jung Kim
    Scientific Reports.2023;[Epub]     CrossRef
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    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
  • Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment: A Focus on Deceased Patients with Hematologic Neoplasms
    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
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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
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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
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    The Korean Journal of Hospice and Palliative Care.2022; 25(1): 1.     CrossRef
  • Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship
    Dayeong Kim, Subin Kim, Kyoung Hwa Lee, Sang Hoon Han
    Journal of Microbiology, Immunology and Infection.2022; 55(4): 651.     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
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    BMC Palliative Care.2022;[Epub]     CrossRef
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    Sunjung Kim, Sunghee H. Tak
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  • Changes in decision-making process for life-sustaining treatment in patients with advanced cancer after the life-sustaining treatment decisions-making act
    Hyeyeong Kim, Hyeon-Su Im, Kyong Og Lee, Young Joo Min, Jae-Cheol Jo, Yunsuk Choi, Yoo Jin Lee, Daseul Kang, Changyoung Kim, Su-Jin Koh, Jaekyung Cheon
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  • 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
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  • Current Status and Cardinal Features of Patient Autonomy after Enactment of the Life-Sustaining Treatment Decisions Act in Korea
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Discrepancies of the Values on the Withholding Futile Interventions between Physician and Family Members of Terminal Cancer Patients
Do Youn Oh, Mi Ra Kim, In Sil Choi, Yo Han Joh, Byung Su Kim, Do Yeun Kim, Jee Hyun Kim, Se Hoon Lee, Tae You Kim, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim
Cancer Res Treat. 2001;33(4):350-356.   Published online August 31, 2001
DOI: https://doi.org/10.4143/crt.2001.33.4.350
AbstractAbstract PDF
PURPOSE
To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members.
MATERIALS AND METHODS
42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients.
RESULTS
Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia.
CONCLUSION
Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.
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