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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2021.324    [Accepted]
Current Status and Cardinal Features of Patient Autonomy after Enactment of the Life-Sustaining Treatment Decisions Act in Korea
Hwa Jung Kim1, Yu Jung Kim2, Jung Hye Kwon3, Young-Woong Won4, Ha Yeon Lee5, Sun Kyung Baek6, Hyewon Ryu7, Do Yeun Kim8
1Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea
2Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
3Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Chungnam National University College of Medicine, Daejeon, Korea
4Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
5Division of Hematology and Oncology, Department of Internal Medicine, National Medical Center, Seoul, Korea
6Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
7Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
8Division of Hematology and Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
Correspondence  Jung Hye Kwon ,Tel: 82-44-995-4781, Fax: 82-44-995-4782, Email: kwonjhye.onco@gmail.com
Received: March 12, 2021;  Accepted: May 31, 2021.  Published online: June 2, 2021.
*Hwa Jung Kim and Yu Jung Kim contributed equally to this work.
ABSTRACT
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.
Key words: Neoplasms, Death, Withholding treatment, Palliative care, Advance directive
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