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

Objectives: To explore the current experiences and perspectives of patients with chronic obstructive pulmonary disease (COPD) with advance care planning (ACP). Methods: A cross-sectional survey was conducted among patients diagnosed with COPD in the Philippine General Hospital. Results were illustrated using descriptive statistics. Results: A total of 90 patients were interviewed and included in the analysis. Nearly all patients were unfamiliar with the terms ACP (95.55%), end-of-life care (99.89%), and do-not-resuscitate order (100%). The majority expressed a desire to have ACP discussions (94.44%) which were not viewed as distressing and were deemed beneficial (96.67%). Patients who were employed were more likely to express readiness to sign legal papers. Patients living with their nuclear family or living alone, and those with higher COPD assessment test (CAT) scores were more likely to relegate health care decisions to their doctors. Conclusion Most patients with COPD in our cohort are unfamiliar with ACP and have not received ACP discussions. Most think that it will improve healthcare and quality of life. Some demographic and clinical factors may make patients more likely to engage in ACP-related activities.
advance care planning ; chronic obstructive pulmonary disease ; palliative medicine

PURPOSE: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. METHODS: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. RESULTS: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=−3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=−2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=−3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. CONCLUSION: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.
Advance Care Planning ; Advance Directives ; Aged ; Health Care Costs ; Humans ; Long-Term Care ; Nursing Homes ; Terminal Care

The level of end-of-life (EOL) care quality in the Republic of Korea has been regarded as inferior to more advanced countries. The EOL care delivered has varied depending on physicians' perceptions and patients' family requests for care. A consensus guideline on withdrawing life-sustaining therapies, which has been endorsed by the Korean Medical Association, Korean Academy of Medical Sciences, and Korean Hospital Association, was published on 13 October 2009. However, the guideline seems to be still not widely applied in our hospitals. The acknowledgment of patient wish, reflected by such as an advance directives (AD) is the most important ethical and legal requirement in EOL care decisions. However, there are barriers to adopting the AD as a solely legitimate tool of EOL decision making even in Western societies. Advance care planning depending on a patient's condition seems to be a more reasonable approach for better EOL care. For an appropriate advance care planning, open communications between physicians and patients or their surrogates is crucial. The lack of an open approach to discussing EOL care with patients results in inappropriate prolongation of patients' dying process. In summary, physicians, who know the clinical signficance of treatments to be delivered to EOL patients, should play a central role based on the 2009 consensus guideline to help patients and their families make good decisions on EOL care. EOL care should be individualized to meet a patient's and family's wishes about the forgoing of life-sustaining therapy. Moreover, concerted actions between the public sector and a governmental organization are required to address ongoing public demands for better EOL care. social requests.
Advance Care Planning ; Advance Directives ; Consensus ; Decision Making ; Humans ; Personal Autonomy ; Public Sector ; Republic of Korea ; Terminal Care ; Withholding Treatment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.
Advance Care Planning ; Caregivers ; Consensus ; Hospices ; Humans ; Judgment ; Jurisprudence ; Korea ; Palliative Care ; Patient Care ; Specialization

PURPOSE: This study was performed to explore the preference for care near the end-of-life of nurses who had been working in an acute hospital. s METHODS: Data were collected by using PCEOL-K which was originally developed in U.S. and standardized into Korean version. Two hundred nurses from one acute hospital who agreed to participate in the study filled out questionnaires and 177 questionnaires were analyzed for the study results. RESULTS: Relatively positive preference toward spirituality and pain control and negative preference toward decision making by health care professional were uncovered. CONCLUSION: Nurses consider patient's autonomy, pain control and spirituality as important factors at the end-of-life care. Further studies regarding the preference for the care near the end-of-life of diverse groups such as patients, doctors, and family members are called for.
Advance Care Planning ; Decision Making ; Delivery of Health Care ; Humans ; Patient Preference ; Spirituality ; Surveys and Questionnaires

PURPOSE: The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. MATERIALS AND METHODS: A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses. RESULTS: A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of “terminal state,” and mostrespondents tried to disclose the patient's condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. CONCLUSION: This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.
Advance Care Planning ; Delivery of Health Care ; Drug Therapy ; Education ; Humans ; Korea ; Neoplasm Metastasis ; Recurrence ; Surveys and Questionnaires

BACKGROUND: This study investigated the current status of communication about death and confidence levels concerning death-related issues among Korean adults.METHODS: A survey was conducted to ascertain the frequency of death related communication, factors promoting and impeding such communication, and confidence levels concerning death-related issues. Data of 112 participants who completed the survey were analyzed using descriptive statistics, a chi square test, and multiple logistic regression.RESULTS: More than half of the participants (52.7%–84.0%) appeared to have infrequent (never/at least one) conversations about death or death-related issues. Owing to socio-cultural aspects, death-related communication was considered a taboo or an unpleasant topic of conversation. Additionally, indifference toward death inhibited people from communicating; however, personal experiences of death or morbidity and favorable social contexts promoted communication. Overall, the confidence levels concerning death-related issues was low. Only 17.9%–32.2% of the participants were confident/very confident about their preferences concerning death-related issues. The more people talked about death, the more likely they were to develop a confident attitude toward death-related issues (odds ratio, 3.45; 95% confidence interval, 1.37–8.69).CONCLUSION: This study confirmed that communication about death is being withheld among Koreans, and this could possibly lower their level of confidence regarding death-related issues. To achieve death with dignity, a ‘death culture’ needs to be promoted alongside legislation and infrastructure.
Adult ; Advance Care Planning ; Attitude to Death ; Humans ; Logistic Models ; Personal Autonomy ; Right to Die ; Taboo ; Terminal Care

OBJECTIVE: In this study, we aimed to investigate preferences regarding the disclosure of a dementia diagnosis and advance care planning (ACP) in patients with memory complaints and their families. METHODS: A total of 98 patients who visited the department of psychiatry at a tertiary hospital with memory complaints and 62 family members completed a structured questionnaire. The questionnaire included preferences on disclosure of dementia and cancer diagnosis, awareness and preferences on ACP. RESULTS: In total, 96.9% of patients were willing to know their dementia diagnosis. There were no significant differences in preferences between the diagnosis of cancer and dementia. Only 24.7% of patients and 45.8% of family members have heard of ACP. However, 82.8% of patients agreed on the necessity of ACP under the current condition. Multivariate analysis revealed that younger patients were more likely to agree with necessity for ACP under the current condition. CONCLUSION: In Korea, patients with memory complaints and their family members strongly favored a disclosure of dementia diagnosis. The majority of participants also agreed on the necessity of ACP. More active involvement of patients is needed in treatment decisions and care planning in cases of dementia as well as other life-threatening illnesses.
Advance Care Planning* ; Aged* ; Dementia* ; Diagnosis* ; Disclosure ; Humans ; Korea* ; Memory* ; Multivariate Analysis ; Surveys and Questionnaires ; Tertiary Care Centers