Difficulties Doctors Experience during Life-Sustaining Treatment Discussion after Enactment of the Life-Sustaining Treatment Decisions Act: A Cross-Sectional Study

• Published in: Cancer research and treatment Vol. 53; no. 2; pp. 584 - 592
• Main Authors: Yoo, Shin Hye, Choi, Wonho, Kim, Yejin, Kim, Min Sun, Park, Hye Yoon, Keam, Bhumsuk, Heo, Dae Seog
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01.04.2021; 대한암학회
• Subjects: Adolescent; Adult; Child; Child, Preschool; Communication; Cross-Sectional Studies; Decision Making - physiology; Female; Humans; Infant; Infant, Newborn; Male; Original; Patient Preference - psychology; Physicians - psychology; Surveys and Questionnaires; Terminal Care - methods; Young Adult; 의학일반; Terminal cancer; End-of-life care; Life-sustaining treatment; Decision making; Discussion
• ISSN: 1598-2998; 2005-9256; 2005-9256
• DOI: 10.4143/crt.2020.735

Purpose This study aimed to investigate difficulties doctors experience during life-sustaining treatment (LST) discussion with seriously ill patients and their families after enactment of the LST Decisions Act in February 2018.Materials and Methods A cross-sectional survey was conducted in a tertiary hospital in the Republic of Korea in August 2019. Six hundred eighty-six doctors who care for seriously ill patients were given a structured questionnaire, and difficulties during the discussion were examined.Results One hundred thirty-two doctors completed the questionnaire. Eighty-five percent answered they treat cancer patients. Most (86.4%) experienced considerable difficulties during LST discussions (mean score, 7.4±1.6/10). The two most common difficulties were communication with patients and family and determining when to discuss LST. Two-thirds of doctors found direct discussions with the patient difficult and said they would initiate LST discussions only with family. LST discussions were actually initiated later than considered appropriate. When medically assessing whether the patient is imminently dying, 56% of doctors experienced disagreements with other doctors, which could affect their decisions.Conclusion This study found that most doctors experienced serious difficulties regarding communication with patients and family and medical assessment of dying process during LST discussions. To alleviate these difficulties, further institutional support is needed to improve the LST discussion between doctors, patients, and family.