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Original Article
Ethics
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 Crit Care. 2024;39(2):294-303.   Published online May 24, 2024
DOI: https://doi.org/10.4266/acc.2023.01130
  • 337 View
  • 37 Download
AbstractAbstract PDFSupplementary Material
Background
The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.
Review Article
Basic science and research
Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review
Christantie Effendy, Yodang Yodang, Sarah Amalia, Erna Rochmawati
Acute Crit Care. 2022;37(4):516-526.   Published online October 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00745
  • 4,750 View
  • 348 Download
  • 3 Web of Science
  • 6 Crossref
AbstractAbstract PDF
The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

Citations

Citations to this article as recorded by  
  • A necessidade dos cuidados paliativos na Unidade de Terapia Intensiva (UTI)
    Larissa Kênia de Oliveira Barros Dos Santos, Isabella Rodrigues Ribeiro, João Pedro Manduca Ferreira, Victor Hugo Oliveira Moraes, Érika Aguiar Lara Pereira
    Cuadernos de Educación y Desarrollo.2024;[Epub]     CrossRef
  • End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
    Andrea Cortegiani, Mariachiara Ippolito, Sebastiano Mercadante
    Anesthesiology Clinics.2024;[Epub]     CrossRef
  • What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review
    Nabat Almalki, Breidge Boyle, Peter O’Halloran
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer
    Irene Giannubilo, Linda Battistuzzi, Eva Blondeaux, Tommaso Ruelle, Francesca Benedetta Poggio, Giulia Buzzatti, Alessia D’Alonzo, Federica Della Rovere, Maria Maddalena Latocca, Chiara Molinelli, Maria Grazia Razeti, Simone Nardin, Luca Arecco, Marta Per
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Palliative Care in the Intensive Care Unit: The Standard of Care
    Clareen Wiencek
    AACN Advanced Critical Care.2024; 35(2): 112.     CrossRef
  • Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotlan
    Satyajit Ray, Emma Victoria McLorie, Jonathan Downie
    Healthcare.2023; 11(17): 2438.     CrossRef
Original Articles
Ethics
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute Crit Care. 2020;35(3):179-188.   Published online August 10, 2020
DOI: https://doi.org/10.4266/acc.2020.00136
  • 6,869 View
  • 211 Download
  • 9 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Citations

Citations to this article as recorded by  
  • 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
  • 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
  • Dying in the ICU
    Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
    Die Anaesthesiologie.2022; 71(12): 930.     CrossRef
  • Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
    Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
    Acute and Critical Care.2022; 37(2): 237.     CrossRef
  • Factors Influencing the Initiative Behavior of Intensive Care Unit Nurses toward End-of-Life Decision Making: A Cross-Sectional Study
    Jingying Huang, Haiou Qi, Yiting Zhu, Minyan Zhang
    Journal of Palliative Medicine.2022; 25(12): 1802.     CrossRef
  • Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
    Yunji Lee, Minjeong Jo, Taehwa Kim, Kyoungsun Yun
    BMJ Open.2021; 11(8): e049711.     CrossRef
Ethics
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
Korean J Crit Care Med. 2014;29(3):160-165.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.160
  • 5,337 View
  • 61 Download
  • 5 Crossref
AbstractAbstract PDF
BACKGROUND
Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients.
METHODS
The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively.
RESULTS
Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment.
CONCLUSIONS
The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.

Citations

Citations to this article as recorded by  
  • Agreement between Family Members and the Physician’s View in the ICU Environment: Personal Experience as a Factor Influencing Attitudes towards Corresponding Hypothetical Situations
    Paraskevi Stamou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva, Vasilios Koulouras
    Healthcare.2023; 11(3): 345.     CrossRef
  • Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study
    Hyeon Jin Cho, Jiyeon Kang
    Journal of Korean Academy of Nursing.2021; 51(1): 15.     CrossRef
  • Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
    Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
    Acute and Critical Care.2020; 35(3): 179.     CrossRef
  • Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey
    Jun Yeun Cho, Ju-Hee Park, Junghyun Kim, Jinwoo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Sang-Min Lee, Jae-Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Critical Care Medicine.2019; 47(9): 1208.     CrossRef
  • Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
    Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Acute and Critical Care.2018; 33(2): 95.     CrossRef
A Survey of Patients Who Were Admitted for Life-Sustaining Therapy in Nationwide Medical Institutions
Jong Myon Bae, Joo Young Gong, Jae Ran Lee, Dae Seog Heo, Younsuck Koh
Korean J Crit Care Med. 2010;25(1):16-20.
DOI: https://doi.org/10.4266/kjccm.2010.25.1.16
  • 3,183 View
  • 59 Download
  • 16 Crossref
AbstractAbstract PDF
BACKGROUND
The study focused on figuring out the present status and distribution of the underlying diseases of Korean terminally ill patients (TIP) who were on life-support care (LSC) by conducting a nationwide health care survey.
METHODS
The authors of this study requested that the 308 nationwide hospitals that operate intensive care units answer a questionnaire that asked about the number of admitted TIPs and their underlying diseases at 12 Am, 22 July, 2009. The proportion of TIPs among all the admitted patients and the percentages of the TIP's underlying diseases were calculated.
RESULTS
In a total of 83.1% of the eligible hospitals responded, the proportion of TIP was 1.6 of 100 admitted patients. Terminal cancer was the leading underlying disease in the TIPs (42.4%). Five % of the patients on LSC were brain dead. More TIPs were admitted in the national/public or university hospitals than in the private or non-university hospitals.
CONCLUSIONS
Futile treatment seems to be administered to the TIPs in Korean hospitals. The quality of terminal care in Korean hospitals should be improved by the application of socially acceptable LSC guidelines. Timely government health plans, including hospice care, to improve the quality of palliative care should be launched and maintained.

Citations

Citations to this article as recorded by  
  • Attitudes, Perceptions, and Experiences toward End-of-Life Care Decision-Making among Intensive Care Unit Nurses in Korea : An Integrative Review
    JiYeon Choi, Youn-Jung Son, Kyounghoon Lee
    Journal of Korean Critical Care Nursing.2020; 13(1): 27.     CrossRef
  • Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
    Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Acute and Critical Care.2018; 33(2): 95.     CrossRef
  • A literature review on end-of-life care among Korean Americans
    Hye-young K Park, Cristina C Hendrix
    International Journal of Palliative Nursing.2018; 24(9): 452.     CrossRef
  • Attitude, Role Perception and Nursing Stress on Life Sustaining Treatment among Intensive Care Unit Nurses
    Su Jeong Lee, Hye Young Kim
    Korean Journal of Adult Nursing.2017; 29(2): 131.     CrossRef
  • End‐of‐life communication in Korean older adults: With focus on advance care planning and advance directives
    Dong Wook Shin, Ji Eun Lee, BeLong Cho, Sang Ho Yoo, SangYun Kim, Jun‐Hyun Yoo
    Geriatrics & Gerontology International.2016; 16(4): 407.     CrossRef
  • The Current Status of End-of-Life Care in Korea and Legislation of Well-Dying Act
    Ji Eun Lee, Ae Jin Goo, Be Long Cho
    Journal of the Korean Geriatrics Society.2016; 20(2): 65.     CrossRef
  • The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
  • Comparing the Preference for Terminal Care in Nurses and Patients
    Dong Soon Kim, AeYoung So, Kyung-Sook Lee, Jung Sook Choi
    Journal of muscle and joint health.2013; 20(3): 214.     CrossRef
  • Life-Sustaining Medical Treatment for Terminal Patients in Korea
    Dae Seog Heo
    Journal of Korean Medical Science.2013; 28(1): 1.     CrossRef
  • The End-of-Life Care in the Intensive Care Unit
    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
  • Factors Affecting Shared Decision Making at End of Life in Korean Adults
    Jo Kae-Hwa, An Gyeong-Ju
    Holistic Nursing Practice.2013; 27(6): 329.     CrossRef
  • On the life-sustaining treatment in Korea
    Yoon-seong Lee
    Journal of the Korean Medical Association.2012; 55(12): 1161.     CrossRef
  • Current status of end-of-life care in Korean hospitals
    Younsuck Koh
    Journal of the Korean Medical Association.2012; 55(12): 1171.     CrossRef
  • Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
    Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
    Korean Journal of Critical Care Medicine.2012; 27(1): 16.     CrossRef
  • Predictive Factor s for City Dweller s’ Attitudes toward Death with Dignity
    Kae Hwa Jo, Gyeong Ju An, Gyun Moo Kim, Yeon Ja Kim
    The Korean Journal of Hospice and Palliative Care.2012; 15(4): 193.     CrossRef
  • Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy
    Younsuck Koh, Dae-Seog Heo, Young Ho Yun, Jeong-Lim Moon, Hyoung Wook Park, Ji Tae Choung, Hyo Sung Jung, Bark Jang Byun, Yoon-Seong Lee
    Journal of the Korean Medical Association.2011; 54(7): 747.     CrossRef

ACC : Acute and Critical Care