End-of-Life Decision Making in Patients with Advanced Dementia: The Perspectives of the Korean General Population and Clinicians
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Objective Korea’s transition into a super-aged society brings to the forefront the escalating dementia prevalence and the consequent rise in mortality, highlighting the need for effective end-of-life (EOL) care strategies. Despite legislative advancements, gaps remain in addressing the medical and ethical challenges of EOL care for patients with advanced dementia, particularly in evaluating treatment options like nasogastric tube (NGT) use and mechanical ventilation (MV). This study investigates the attitudes of the general population (GP) and clinicians in Korea towards EOL treatment decisions.Methods A cross-sectional, web-based survey was conducted among 500 members of the GP and 200 clinicians from a university hospital. Case vignettes were used to assess attitudes towards EOL treatment decisions, specifically focusing on NGT and MV use, and to explore the influencing factors.Results There was a notable difference in favorable attitudes toward NGT withdrawal between the GP (62.2%) and clinicians (39.0%). Otherwise, both groups showed higher acceptance of MV withholding (82.2% [GPs] and 82.5% [clinicians]) when informed of the patient’s verbal intention regarding life-sustaining treatment (LST), and attitudes were more positive with written advance directives. Also, it was decreased when patient intentions were unclear.Conclusion The results suggested the need to consider NGT as a medical intervention requiring a risk-benefit analysis. Although LST decision-making in patients with advanced dementia is still limited in Korea, this study showed the shared recognition among the GP and clinicians of the importance of EOL treatment decisions that consider patient wishes and quality of life for patients with advanced dementia.
Abstract
Objective Korea’s transition into a super-aged society brings to the forefront the escalating dementia prevalence and the consequent rise in mortality, highlighting the need for effective end-of-life (EOL) care strategies. Despite legislative advancements, gaps remain in addressing the medical and ethical challenges of EOL care for patients with advanced dementia, particularly in evaluating treatment options like nasogastric tube (NGT) use and mechanical ventilation (MV). This study investigates the attitudes of the general population (GP) and clinicians in Korea towards EOL treatment decisions.Methods A cross-sectional, web-based survey was conducted among 500 members of the GP and 200 clinicians from a university hospital. Case vignettes were used to assess attitudes towards EOL treatment decisions, specifically focusing on NGT and MV use, and to explore the influencing factors.Results There was a notable difference in favorable attitudes toward NGT withdrawal between the GP (62.2%) and clinicians (39.0%). Otherwise, both groups showed higher acceptance of MV withholding (82.2% [GPs] and 82.5% [clinicians]) when informed of the patient’s verbal intention regarding life-sustaining treatment (LST), and attitudes were more positive with written advance directives. Also, it was decreased when patient intentions were unclear.Conclusion The results suggested the need to consider NGT as a medical intervention requiring a risk-benefit analysis. Although LST decision-making in patients with advanced dementia is still limited in Korea, this study showed the shared recognition among the GP and clinicians of the importance of EOL treatment decisions that consider patient wishes and quality of life for patients with advanced dementia.
참고문헌 (46)
- OECD, "Working better with age : Korea" (2018), OECD Publishing
- "Older adults statistics 2022"[URL]
- Arcand M, "End-of-life issues in advanced dementia : part 1 : goals of care, decision-making process, and family education", Can Fam Physi cian, 61, pp.330~334 (2015)
- Mitchell SL, "The clinical course of advanced dementia", N Engl J Med, 361, pp.1529~1538 (2009)
- Shin DW, "End-of-life commu nication in Korean older adults : with focus on advance care planning and advance directives", Geriatr Gerontol Int, 16, pp.407~415 (2016)
- Jung JH, "Do pa tients want to listen to a diagnosis of dementia in Korea? Preferences on disclosing a diagnosis of dementia and discussing advance care planning in elderly patients with memory concerns and their families", Psychiatry Investig, 14, pp.779~785 (2017)
- Cai S, "Do pa tients with advanced cognitive impairment admitted to hospitals with higher rates of feeding tube insertion have improved survival?", J Pain Symptom Manage, 45, pp.524~533 (2013)
- Mitchell SL, "Terminal care for persons with advanced dementia in the nursing home and home care settings", J Palliat Med, 7, pp.808~816 (2004)
- Zhu Y, "Life-sustaining treatments among Medicare beneficiaries with and without dementia at the end of life", J Alzheimers Dis, 96, pp.11831193~ (2023)
- Seymour J, "Implementing advance care plan ning : a qualitative study of community nurses’ views and experiences", BMC Palliat Care, 9, pp.4~ (2010)
- "Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life"[URL]
- Casarett D, "Appropriate use of artificial nutrition and hydration--fundamental principles and recommendations", N Engl J Med, 353, pp.2607~2612 (2005)
- Druml C, "ESPEN guideline on ethical aspects of artificial nutrition and hy dration", Clin Nutr, 35, pp.545~556 (2016)
- American Geriatrics Society Ethics Committee, "American Geriatrics Society feeding tubes in advanced dementia position statement", J Am Geriatr Soc, 62, pp.1590~1593 (2014)
- Lam RE, "Nutrition in dementia", CMAJ, 186, pp.1319~ (2014)
- "Dementia"[URL]
- Lunney JR, "Profiles of older Medicare decedents", J Am Geriatr Soc, 50, pp.1108~1112 (2002)
- Lunney JR, "Patterns of func tional decline at the end of life", JAMA, 289, pp.2387~2392 (2003)
- Michel JP, "End-of-life care of persons with dementia", J Gerontol A Biol Sci Med Sci, 57, pp.M640~ (2002)
- Chen JH, "Terminal tra jectories of functional decline in the long-term care setting", J Gerontol A Biol Sci Med Sci, 62, pp.531~536 (2007)
- Mataqi M, "Factors influencing palliative care in advanced dementia : a systematic review", BMJ Support Palliat Care, 10, pp.145156~ (2020)
- Jho HJ, "Changes of end of life practices for cancer patients and their association with hospice palliative care refer ral over 2009-2014 : a single institution study", Cancer Res Treat, 52, pp.419~425 (2020)
- 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)
- Chou HH, "Nasogastric tube feeding versus as sisted hand feeding in-home healthcare older adults with severe de mentia in Taiwan : a prognosis comparison", BMC Geriatr, 20, pp.60~ (2020)
- Teno JM, "Decision-making and outcomes of feeding tube insertion : a five-state study", J Am Geriatr Soc, 59, pp.881~886 (2011)
- Quill TE, "Utilization of nasogastric feeding tubes in a group of chroni cally ill, elderly patients in a community hospital", Arch Intern Med, 149, pp.1937~1941 (1989)
- Mamun K, "Use of physical restraints in nursing homes : current practice in Singapore", Ann Acad Med Singap, 34, pp.158~162 (2005)
- Givens JL, "Hospital transfers of nursing home residents with advanced dementia", J Am Geriatr Soc, 60, pp.905~909 (2012)
- Sampson EL, "Enteral tube feeding for older people with advanced dementia", Cochrane Database Syst Rev, 2009, pp.CD007209~ (2009)
- Mitchell SL, "Tube feeding in US nursing home residents with advanced dementia, 2000-2014", JAMA, 316, pp.769~770 (2016)
- van der Steen JT, "White paper defining optimal palliative care in older people with dementia : a Delphi study and recommendations from the European Association for Palliative Care", Palliat Med, 28, pp.197~209 (2014)
- End-of-life and palliative care for people with dementia framework, "Government of Western Australia, Department of Health", Department of Health, ~ (2021)
- North West Coast Strategic Clinical Network, "Palliative care guidelines in dementia" (2018), NHS
- Richardson SS, "Use of aggressive medical treatments near the end of life : differences between patients with and without dementia", Health Serv Res, 42(1 Pt 1), pp.183~200 (2007)
- Pisani MA, "Short-term outcomes in older intensive care unit patients with demen tia", Crit Care Med, 33, pp.1371~1376 (2005)
- Salluh JI, "Outcome of delirium in critically ill patients : systematic review and meta-analysis", BMJ, 350, pp.h2538~ (2015)
- Lagu T, "Dementia and outcomes of mechanical ventilation", J Am Geriatr Soc, 64, pp.e63~e66 (2016)
- Teno JM, "Association of increasing use of mechanical ventilation among nursing home residents with advanced dementia and intensive care unit beds", JAMA Intern Med, 176, pp.1809~1816 (2016)
- Ely EW, "Delirium as a predictor of mortality in mechanically ventilated pa tients in the intensive care unit", JAMA, 291, pp.1753~1762 (2004)
- Kissane LA, "End-of-life preferences of the general public : results from a Japanese national survey", Health Policy, 119, pp.1472~1481 (2015)
- Kwak J, "Attitudes and preferences of Korean-American old er adults and caregivers on end-of-life care", J Am Geriatr Soc, 55, pp.1867~1872 (2007)
- Yun YH, "Public attitudes toward dying with dignity and hospice · palliative care", J Hosp Palliat Care, 7, pp.17~28 (2004)
- Lee JE, "Caregiver bur den, patients’ self-perceived burden, and preference for palliative care among cancer patients and caregivers", Psychooncology, 24, pp.15451551~ (2015)
- Chen DR, "Gender differences in the inten tion to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse", BMC Palliat Care, 21, pp.171~ (2022)
- "Trends and variation in end-of-life care for Medicare beneficiaries with severe chronic ill ness"[URL]
- Kelley AS, "Deter minants of treatment intensity for patients with serious illness : a new conceptual framework", J Palliat Med, 13, pp.807~813 (2010)