Recently, the Well-dying Act was legislated in Korea, and it will come into force in 2018. The rapid aging of this society has made many older patients and their families suffer from pain and disability for a long time towards the end of life. Hospice care, when compared to life-sustaining treatment, can relieve such burdens. Regarding the decision of choosing hospice care at the end of life, advance care planning and advance directives can help people express their preference beforehand. In Korea, hospice care is still not actively used and most patients endure life-sustaining treatment until death. Many patients want hospice care, but there has not been a legal basis for such a decision, leading to social conflict and many legal problems. The Well-dying Act will provide a legal basis for such a decision. This will help establish and promote hospice care in Korea. However, sufficient discussion and preparation are required before enforcing the Act.
Advance Care Planning ; Advance Directives ; Aging ; Hospice Care ; Humans ; Korea*

PURPOSE: The purposes of this study were to identify awareness and attitudes toward advance directives (ADs) among Korean adults and to examine various opinions in the utilization of ADs among young, middle-aged, and older adults. METHODS: Data were collected using a structured questionnaire from 384 adults selected by a quota sampling method on the basis of age. RESULTS: The majority of participants preferred that they themselves would be the primary decision maker. Most of them were unaware of the option of ADs but supported the utilization of ADs. Most of the participants preferred detailed descriptions on end-of-life decisions in ADs but wanted to allow some leeway in following it. Significant differences were found among age groups in terms of the preferences regarding the utilization of ADs. CONCLUSION: It is suggested that nurses make efforts to educate the general public about ADs and facilitate advance care planning, which focuses on the process of communication on end-of-life preferences within the social network of relationships.
Adult ; Advance Care Planning ; Advance Directives ; Humans ; Surveys and Questionnaires

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care.
Advance Directives ; Consensus ; Humans ; Societies, Medical

PURPOSE: This study evaluates the feasibility of Korean Advance Directives (K-AD) developed earlier. METHODS: From January 1 to February 28, 2013, data were collected from 330 adults through a self-reported questionnaire established by the authors based on literature review and expert consultation. The feasibility of K-AD was multi-dimensionally evaluated through four criteria: cognitive, psychological, document making and socially expecting aspects. Data were analyzed using t tests, one-way ANOVA, and Scheffe post hoc tests via the SAS 9.1.3 program. RESULTS: The feasibility of K-AD differed significantly by gender (p=.003), educational level (p<.001), religion (p=.002), and self-reported health status (p=.039). Differences in the level of easiness with K-AD by gender (p=.008) and education (p=.047) were significant. Perceived simplicity of AD differed significantly by religion (p=.005), and the necessity of AD differed significantly by gender (p=.025) and religion (p=.005). CONCLUSION: K-AD are sufficiently feasible to be tentatively utilized in practice. This is the first study to explore the feasibility of K-AD on the basis of multiple aspects. However, further studies involving diverse populations and methodologies to validate the usefulness of K-AD are warranted.
Adult ; Advance Directives* ; Analysis of Variance ; Education ; Humans ; Surveys and Questionnaires

PURPOSE:In many countries, patients and dialysis unit physicians attempt to address issues regarding withholding and withdrawing dialysis through advance directives and clinical guidelines for dialysis utilization. However, there are only a few reports of withholding and withdrawing dialysis in Korea. This study was developed to investigate the attitudes of dialysis unit physicians regarding withholding and withdrawing dialysis in Korea. METHODS:A questionnaire survey was conducted among 45 dialysis unit physicians from January, 2006 to January, 2008. Physicians were asked about their decision making process to withhold and withdraw dialysis, and their opinions regarding the necessities of advance directives and guidelines for withholding and withdrawing dialysis. RESULTS:Analysis of surveys revealed that physicians agreed more about whether to withhold and withdraw dialysis in vegetative patients compared to patients with dementia ( p<0.001, p<0.001). There were more agreements about whether to withhold dialysis than whether to withdraw dialysis in patients with unimpaired cognition ( p<0.037). However, there were no differences in agreements between withholding and withdrawing dialysis in patients with severe neurological impairments. There appeared to be a general consensus regarding the need for guidelines addressing withholding and withdrawing dialysis (84.4%). However, opinions supporting the necessity for advance directives were not strongly favored (33.3%). CONCLUSION:Conflicting opinions are present among dialysis unit physicians regarding whether to withhold and withdraw dialysis according to a patient's neurological impairments. However, most dialysis unit physicians were of one accord regarding the need of guidelines for withholding and withdrawing dialysis.
Advance Directives ; Cognition ; Consensus ; Decision Making ; Dementia ; Dialysis ; Humans ; Korea

PURPOSE:In many countries, patients and dialysis unit physicians attempt to address issues regarding withholding and withdrawing dialysis through advance directives and clinical guidelines for dialysis utilization. However, there are only a few reports of withholding and withdrawing dialysis in Korea. This study was developed to investigate the attitudes of dialysis unit physicians regarding withholding and withdrawing dialysis in Korea. METHODS:A questionnaire survey was conducted among 45 dialysis unit physicians from January, 2006 to January, 2008. Physicians were asked about their decision making process to withhold and withdraw dialysis, and their opinions regarding the necessities of advance directives and guidelines for withholding and withdrawing dialysis. RESULTS:Analysis of surveys revealed that physicians agreed more about whether to withhold and withdraw dialysis in vegetative patients compared to patients with dementia ( p<0.001, p<0.001). There were more agreements about whether to withhold dialysis than whether to withdraw dialysis in patients with unimpaired cognition ( p<0.037). However, there were no differences in agreements between withholding and withdrawing dialysis in patients with severe neurological impairments. There appeared to be a general consensus regarding the need for guidelines addressing withholding and withdrawing dialysis (84.4%). However, opinions supporting the necessity for advance directives were not strongly favored (33.3%). CONCLUSION:Conflicting opinions are present among dialysis unit physicians regarding whether to withhold and withdraw dialysis according to a patient's neurological impairments. However, most dialysis unit physicians were of one accord regarding the need of guidelines for withholding and withdrawing dialysis.
Advance Directives ; Cognition ; Consensus ; Decision Making ; Dementia ; Dialysis ; Humans ; Korea

PURPOSE: This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients. METHODS: A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. RESULTS: The participants' knowledge level on advance directive was 5.47±2.08 out of 9, the attitudes towards the withdrawal of life-sustaining treatment was 3.22±0.49 out of 5, and the quality of life was 3.35±0.92 out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036). CONCLUSION: According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.
Advance Directives* ; Education ; Humans ; Quality of Life* ; Renal Dialysis*

PURPOSE: This study was done to identify differences in awareness and ethical attitudes associated with Do-Not-Resuscitate (DNR) and decision about advance directives among the general populations. METHODS: Participants were 193 ordinary people from 2 provinces and data were collected from December 23, 2013 to January 30, 2014. Structured questionnaires included awareness measuring tool and ethical attitudes measuring tool. Data were analyzed with descriptive analysis using descriptive statistics, t-test, and chi2-test with SPSS/WIN 18.0 program. RESULTS: Most of the participants responded that they agreed on the necessity of DNR and needed to do it by guidelines, while 47.2% responded that patients and their families should make a decision about the DNR. After the decision about DNR, they also agreed that efforts should be made to give the best treatment even if a DNR decision had been made by the patient. In general, there was a significant difference in advance directives for CPR depending on gender and living with family or not. CONCLUSION: For a professional and systematic approach to the problem, DNR guidelines sufficient to elicit social consensus are needed.
Advance Directives* ; Cardiopulmonary Resuscitation ; Consensus ; Humans ; Surveys and Questionnaires ; Resuscitation Orders

PURPOSE: The purpose of this study was to identify the relationships among nursing students' knowledge, attitudes to advance medical directives and ethics values. METHODS: The study was a cross-sectional and descriptive survey, carried out with 232 students from two schools of nursing, one located in B and C city. Student nurses' knowledge, attitudes for advance medical directives and ethics values were measured using structured self-report questionnaires. Data were analyzed using t-test or one-way ANOVA, and Pearson correlation coefficients. RESULTS: The scores for knowledge, attitudes for medical advance directives were 7.18 and 3.07, and for ethics values, 3.47. Nursing students' knowledge and attitude showed a significant difference depending on grade. Nursing students' ethics values showed significant differences depending on whether a study on ethics had been completed. A positive correlation was observed between nursing students' knowledge, attitudes for advance medical directives and ethics values. CONCLUSION: The results of this study indicate that basic data for the development of an effective education program on ethics is important in establishing a positive attitude toward advance medical directives and the appropriate ethical values in student nurses.
Advance Directives ; Education ; Ethics ; Humans ; Nursing ; Students, Nursing

PURPOSE: Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses.METHOD: This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire.RESULTS: The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005).CONCLUSION: Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.
Advance Directives ; Cross-Sectional Studies ; Learning ; Methods ; Seoul ; Terminal Care