Adopting Advance Directives Reinforces Patient Participation in End-of-Life Care Discussion
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Purpose In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives. Materials and Methods Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated. Results Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients’ poor condition after late referral was the main barrier to missing EOL discussions; however, family members’ concerns about patient’s distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively. Conclusion Our results suggested that the use of advance directive promote patient participation in EOL discussion.
Abstract
Purpose In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives. Materials and Methods Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated. Results Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients’ poor condition after late referral was the main barrier to missing EOL discussions; however, family members’ concerns about patient’s distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively. Conclusion Our results suggested that the use of advance directive promote patient participation in EOL discussion.
참고문헌 (24)
- "Clinical practice guidelines for quality palliative care, 3rd ed" (2013)[URL]
- 허대석, "환자의 자기결정권과 사전의료지시서", 대한의사협회지, 52(9), pp.865~870 (2009), 대한의사협회
- 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)
- Ngo-Metzger Q, "Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients", Am J Med, 115, pp.47~53 (2003)
- Andreis F, "Chemotherapy use at the end of life : a retrospective single centre experience analysis", Tumori, 97, pp.30~34 (2011)
- 홍지형, "Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients", Cancer Research and Treatment, 45(4), pp.270~275 (2013), 대한암학회[DOI]
- Keam B, "Aggressiveness of cancer-care near the end-of-life in Korea", Jpn J Clin Oncol, 38, pp.381~386 (2008)
- Kim DY, "Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea", J Palliat Med, 10, pp.1153~1158 (2007)
- Oh DY, "CPR or DNR? End-of-life decision in Korean cancer patients: a single center's experience", Support Care Cancer, 14, pp.103~108 (2006)
- 김훈교, "호스피스 병동에서 시행되는 말기 암 환자의 DNR 동의", 한국호스피스완화의료학회지, 7(2), pp.232~237 (2004), 한국호스피스완화의료학회
- 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)
- Park IK, "Differences in end-of-life care decision making between patients with and without cancer", Am J Hosp Palliat Care, 32, pp.797~801 (2015)
- Anselm AH, "Barriers to communication regarding end-of-life care : perspectives of care providers", J Crit Care, 20, pp.214~223 (2005)
- Weiss GL, "The do-not-resuscitate decision : the context, process, and consequences of DNR orders", Death Stud, 24, pp.307~323 (2000)
- Danis M, "A prospective study of advance directives for life-sustaining care", N Engl J Med, 324, pp.882~888 (1991)
- Heintz LL, "Efficacy of advance directives in a general hospital", Hawaii Med J, 56, pp.203~206 (1997)
- Brown BA, "The history of advance directives : a literature review", J Gerontol Nurs, 29, pp.4~14 (2003)
- 남양훈, "말기 신부전 환자에서 사전의사결정서의 적용", Kidney Research and Clinical Practice, 27(1), pp.85~93 (2008), 대한신장학회
- Schmidt TA, "Physician orders for life-sustaining treatment(POLST) : lessons learned from analysis of the Oregon POLST Registry", Resuscitation, 85, pp.480~485 (2014)
- Fromme EK, "Association between physician orders for life-sustaining treatment for scope of treatment and in-hospital death in Oregon", J Am Geriatr Soc, 62, pp.1246~1251 (2014)
- Schneiderman LJ, "Effects of offering advance directives on medical treatments and costs", Ann Intern Med, 117, pp.599~606 (1992)
- Reilly BM, "Promoting inpatient directives about life-sustaining treatments in a community hospital : results of a 3-year time-series intervention trial", Arch Intern Med, 155, pp.2317~2323 (1995)
- Pautex S, "Preferences of elderly cancer patients in their advance directives", Crit Rev Oncol Hematol, 74, pp.61~65 (2010)
- 공봉한, "Experience of Advance Directives in a Hospice Center", Journal of Korean Medical Science, 30(2), pp.151~154 (2015), 대한의학회