Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients with Terminal Cancer
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Purpose Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. Materials and Methods Patients with terminal cancer, age 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians’ or patients’ barriers were also collected. Results From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians’ barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients’ barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). Conclusion One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.
Abstract
Purpose Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. Materials and Methods Patients with terminal cancer, age 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians’ or patients’ barriers were also collected. Results From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians’ barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients’ barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). Conclusion One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.
참고문헌 (30)
- Korean Supreme Court, "Withdrawing futile life-sustaining treatment", Korean Supreme Court, ~ (2009)
- Ministry of Health and Welfare, "Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life", Ministry of Health and Welfare, ~ (2016)
- Royal College of Physicians, "Advance care planning: concise guideline to good practice, No. 12" (2009), Royal College of Physicians
- Houben CH, "Efficacy of advance care planning : a systematic review and meta-analysis", J Am Med Dir Assoc, 15, pp.477~489 (2014)
- Keam B, "The attitudes of Korean cancer patients, family caregivers, oncologists, and members of the general public toward advance directives", Support Care Cancer, 21, pp.1437~1444 (2013)
- Kim S, "Feasibility of the Korean-advance directives among community-dwelling elderly persons", Holist Nurs Pract, 31, pp.234~242 (2017)
- Yun YH, "The attitudes of cancer patients and their families toward the disclosure of terminal illness", J Clin Oncol, 22, pp.307~314 (2004)
- 허대석, "환자의 자기결정권과 사전의료지시서", 대한의사협회지, 52(9), pp.865~870 (2009), 대한의사협회
- Lee JK, "Surrogate decision-making in Korean patients with advanced cancer : a longitudinal study", Support Care Cancer, 21, pp.183~190 (2013)
- Kwon SH, "Most advance directives written by patients with advanced cancer or their proxies request only minimally invasive treatments during end-of-life care", Am J Hosp Palliat Care, 29, pp.622~626 (2012)
- 이상민, "말기와 임종과정에 대한 정의 및 의학적 판단지침", 대한의사협회지, 61(8), pp.509~521 (2018), 대한의사협회[DOI]
- Alano GJ, "Factors influencing older adults to complete advance directives", Palliat Support Care, 8, pp.267~275 (2010)
- McDonald JC, "Advance directives in patients with advanced cancer receiving active treatment : attitudes, prevalence, and barriers", Support Care Cancer, 25, pp.523~531 (2017)
- Salmond SW, "Attitudes toward advance directives and advance directive completion rates", Orthop Nurs, 24, pp.117~127 (2005)
- Phipps E, "Approaching the end of life : attitudes, preferences, and behaviors of African-American and white patients and their family caregivers", J Clin Oncol, 21, pp.549~554 (2003)
- Lammers AJ, "The oncology specialist's role in POLST form completion", Am J Hosp Palliat Care, 35, pp.297~303 (2018)
- Tarzian AJ, "Maryland's medical orders for lifesustaining treatment form use : reports of a statewide survey", J Palliat Med, 20, pp.939~945 (2017)
- 공봉한, "Experience of Advance Directives in a Hospice Center", Journal of Korean Medical Science, 30(2), pp.151~154 (2015), 대한의학회
- Kim S, "End-of-life care decisions using a Korean advance directive among cancer patient-caregiver dyads", Palliat Support Care, 15, pp.77~87 (2017)
- You JJ, "Barriers to goals of care discussions with seriously ill hospitalized patients and their families : a multicenter survey of clinicians", JAMA Intern Med, 175, pp.549~556 (2015)
- Simon J, "'Not yet' and 'Just ask' : barriers and facilitators to advance care planning : a qualitative descriptive study of the perspectives of seriously ill, older patients and their families", BMJ Support Palliat Care, 5, pp.54~62 (2015)
- Travers A, "What are the barriers to initiating endof-life conversations with patients in the last year of life?", Int J Palliat Nurs, 22, pp.454~462 (2016)
- De Vleminck A, "Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences", PLoS One, 9, pp.e84905~ (2014)
- Hubert E, "Cancer patients and advance directives : a survey of patients in a hematology and oncology outpatient clinic", Onkologie, 36, pp.398~402 (2013)
- Ivo K, "A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan", J Med Ethics, 38, pp.310~316 (2012)
- Hagen NA, "Advance care planning: identifying system-specific barriers and facilitators", Curr Oncol, 22, pp.e237~e245 (2015)
- Kirchhoff KT, "Effect of a disease-specific advance care planning intervention on end-of-life care", J Am Geriatr Soc, 60, pp.946~950 (2012)
- 이찬희, "진료과별 적정 외래 진료시간에 관한 연구", 보건행정학회지, 24(3), pp.254~260 (2014), 한국보건행정학회[DOI]
- Back AL, "Efficacy of communication skills training for giving bad news and discussing transitions to palliative care", Arch Intern Med, 167, pp.453~460 (2007)
- Butler M, "Decision aids for advance care planning : an overview of the state of the science", Ann Intern Med, 161, pp.408~418 (2014)