Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-04T18:37:34.833Z Has data issue: false hasContentIssue false
  • English
  • Français

End-of-life care decisions using a Korean advance directive among cancer patient–caregiver dyads

Published online by Cambridge University Press:  02 November 2016

Shinmi Kim ,
Sujin Koh ,
Kwonoh Park  and
Jinshil Kim
Shinmi Kim*
Affiliation:
Department of Nursing, Changwon National University, Changwon, Republic of Korea
Sujin Koh
Affiliation:
Department of Hematology and Oncology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
Kwonoh Park
Affiliation:
Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
Jinshil Kim
Affiliation:
College of Nursing, Gachon University, Incheon, Republic of Korea
*
Address correspondence and reprint requests to: JinShil Kim, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, South Korea. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The Korean advance directive (K–AD) comprises a value statement, treatment directives, preferences for cardiopulmonary resuscitation (CPR), artificial ventilation, tube feeding, and hospice care, as well as a proxy appointment. The K–AD can facilitate a patient's decision making with respect to end-of-life (EoL) care. The present study aimed to examine the extent to which patient–caregiver dyads would use the K–AD and agree on EoL care decisions.

Methods:

Using a descriptive study design, 81 cancer patients were invited to participate. The final sample consisted of 44 patient–caregiver dyads who completed survey questionnaires, including the K–AD. One patient did not complete all parts of the questionnaire, and 36 (44.4%) declined to participate. Content analysis was conducted to examine the K–AD value statements. Cohen's kappa coefficient was calculated to determine the degree of patient–caregiver dyadic agreement on K–AD treatment directives (Sudore & Fried, 2010).

Results:

Our patient participants had the following cancer diagnoses: colorectal 29.5%, breast 29.5%, and liver/biliary tract cancers, 15.9%. Half of the sample had advanced-stage disease. Spouses (70.5%) or adult children (20.4%) were the primary caregivers, with perceived bonding rated as fair (31.8%) or good (65.9%). Rejection of the K–AD was mainly due to the difficulty involved in deciding on EoL care (50%). Comfort while dying was the most common theme expressed by patients (73.8%) and caregivers (66.7%). In terms of treatment directives, dyads advocated for hospice care (66.7%) and reduced support for aggressive treatments of CPR or artificial ventilation. The use of CPR (κ = 0.43, p = 0.004) and artificial ventilation (κ = 0.28, p = 0.046) showed significantly mild to moderate concordance among the dyads. Some 16 of the 21 dyads identified their spouses as a proxy, with others designating their adult children.

Significance of results:

The degree of patient–caregiver concordance on the K–AD seemed applicable, and achieved mild to moderate concordance. Our findings are exploratory but suggest the need for EoL discussions where patient–caregiver dyads are encouraged to participate in EoL care decision making.

Keywords

Korean advance directivesCancer patientsCaregiversEnd-of-life decision making
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 1 , February 2017 , pp. 77 - 87
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Cancer Society (2015). Advance directives: Why do you need an advance directive? Available from http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/advancedirectives/advance-directives-why-do-we-need-advance-directives.Google Scholar
Caswell, G., Pollock, K., Harwood, R., et al. (2015). Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: A qualitative study. BMC Palliative Care, 14, 35. Epub ahead of print Aug 1. Available from http://www.pubpdf.com/pub/26231339/Communication-between-family-carers-and-health-professionals-about-end-of-life-care-for-older-people.Google Scholar
Choi, Y., Keam, B., Lee, S.H., et al. (2015). Cancer treatment near the end of life becomes more aggressive: Changes in trend during 10 years at a single institute. Cancer Research and Treatment, 47(4), 555–563. Epub ahead of print Feb 16. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614190/.Google Scholar
Heo, D. (2008). End-of-life decision in Korea. Journal of the Korean Medical Association, 51(6), 524–529.Google Scholar
Heyland, D.K., Cook, D.J., Rocker, G.M., et al. (2010). Defining priorities for improving end-of-life care in Canada. Canadian Medical Association Journal, 182(16), E747–E752. Epub ahead of print Oct 4. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972350/.Google Scholar
Hong, S.W. & Kim, S. (2013). Knowledge regarding advance directives among community-dwelling elderly. Journal of the Korean Academic Society of Nursing Education, 19(3), 330–340.Google Scholar
Hsieh, H.F. & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.Google Scholar
Jung, K.W., Park, S., Kong, H.J., et al. (2012). Cancer statistics in Korea: Incidence, mortality, survival, and prevalence in 2012. Cancer Research and Treatment, 47(2), 127–141.CrossRefGoogle Scholar
Keam, B., Yun, Y.H., Heo, D.S., et al. (2013). The attitudes of Korean cancer patients, family caregivers, oncologists, and members of the general public toward advance directives. Supportive Care in Cancer, 21(5), 1437–1444. Epub ahead of print Dec 22, 2012.Google Scholar
Kim, C.J., Kim, Y.D., Kim, S.G., et al. (2015). Cancer management, revised bill. Bill no. 14518 [in Korean]. Available from http://likms.assembly.go.kr/bill/jsp/BillDetail.jsp?bill_id=PRC_C1C5S0N4N0O1D1Z1W0X4O4C2T5W8M3.Google Scholar
Kim, S.M., Hong, S.W., Eun, Y., et al. (2012). Prerequisite for Korean advance directives: From the view of healthcare providers. Journal of the Korean Academy of Nursing, 42(4), 486–495.Google Scholar
Kim, S.M., Hong, Y.S., Hong, S.W., et al. (2013 a). Development of a Korean version of an advance directive model via cognitive interview. Korean Journal of Hospice and Palliative Care, 16(1), 20–32.Google Scholar
Kim, J., Kim, S.M. & Hong, S.W. (2013 b). Facilitators and barriers to use of advance directives in Korea. Journal of Hospice & Palliative Nursing, 15(7), 410–418.Google Scholar
Kim, J., Kim, S., Hong, Y.S., et al. (2014). Professional opinions on advance directives in Korea. Journal of Hospice & Palliative Nursing, 16(5), 273–281.Google Scholar
Koh, S.J., Kim, S. & Kim, J. (2015). Communication for end-of-life care planning among Korean patients with terminal cancer: A context-oriented model. Palliative & Supportive Care, 14(1), 69–76. Epub ahead of print Jul 3.Google Scholar
Korean Ministry of Government Legislation (2014). Cancer management act no. 11690, part 4: Palliative care for terminal cancer patients [in Korean]. Available from http://www.law.go.kr/lsSc.do?menuId=0&subMenu=1&query=%EC%95%94%EA%B4%80%EB%A6%AC%EB%B2%95#liBgcolor0.Google Scholar
Korean Supreme Court Ruling (2004). Murder (assisted murder) [in Korean]. Document no. [Gong2004.8.1(207),1255]. Available from http://glaw.scourt.go.kr/wsjo/panre/sjo100.do?contId=2061295&q=%EA%B3%B52004.8.1.(207),1255&nq=&w=total&section=&subw=&subsection=&subId=2&csq=&groups=&category=&outmax=1&msort=&onlycount=&sp=&d1=&d2=&d3=&d4=&d5=&pg=0&p1=&p2=&p3=&p4=&p5=0&p6=&p7=&p8=0&p9=&p10=&p11=&p12=&sysCd=&tabGbnCd=&saNo=&joNo=&lawNm=&hanjaYn=N&userSrchHistNo=&poption=&srch=&range=&daewbyn=N&smpryn=N&tabId=.Google Scholar
Korean Supreme Court Ruling (2009). Withdrawing futile life-sustaining treatment. Document no. [Gong2009Sang, 849] [in Korean]. Available from http://glaw.scourt.go.kr/wsjo/panre/sjo100.do?contId=2059419&q=2009%EB%8B%A417417&nq=&w=yegu&section=yegu_tot&subw=&subsection=&subId=&csq=&groups=&category=&outmax=1&msort=&onlycount=&sp=&d1=&d2=&d3=&d4=&d5=&pg=0&p1=&p2=01&p3=&p4=&p5=&p6=&p7=&p8=&p9=&p10=&p11=&p12=&sysCd=&tabGbnCd=&saNo=&joNo=&lawNm=&hanjaYn=N&userSrchHistNo=&poption=&srch=&range=&daewbyn=N&smpryn=N&tabId=.Google Scholar
Landis, J.R. & Koch, G.G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.Google Scholar
Lee, J.K., Keam, B., An, A.R., et al. (2013). Surrogate decision making in Korean patients with advanced cancer: A longitudinal study. Supportive Care in Cancer, 21(1), 183–190. Epub ahead of print May 31, 2012.Google Scholar
Lee, S.R., Shin, D.S. & Choi, Y.J. (2014). Perceptions of caregivers and medical staff toward DNR and AD. Korean Journal of Hospice and Palliative Care, 17(2), 66–74.Google Scholar
McHugh, M.L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900052/.Google Scholar
Ministry of Health and Welfare (2013). Suggestion for the legislation of a special law of patient self-determination to make life-sustaining treatment [in Korean]. Available from http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=288993&page=1.Google Scholar
Mitchell, I.A., Schuster, A., Lynch, T., et al. (2015). Why don't end-of-life conversations go viral? A review of videos on YouTube. BMJ Supportive & Palliative Care. Epub ahead of print Jul 16. Available from https://scifeeds.com/journal-article/why-dont-end-of-life-conversations-go-viral-a-review-of-videos-on-youtube/.Google Scholar
National Evidence-Based Healthcare Collaborating Agency (2009). A consensus statement on stopping meaningless end-of-life treatments in terminally ill patients [in Korean]. Available from http://www.neca.re.kr/center/researcher/report_view.jsp?boardNo=GA&seq=5&q=626f6172644e6f3d47412663706167653d3126736561726368436f6c3d7375626a6563742673656172636856616c3dc7d5c0c72673656172636853596561723d323030392673656172636845596561723d32303039.Google Scholar
National Law Information Center (2016). Act on hospice/palliative care and end-of-life decision making for life-sustaining-treatment (no. 14013) [in Korean]. Available from http://www.law.go.kr/lsSc.do?menuId=0&subMenu=1&query=%EC%97%B0%EB%AA%85%EC%9D%98%EB%A3%8C#undefined.Google Scholar
Oh, D.Y., Kim, J.E., Lee, C.H., et al. (2004). Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies. Cancer, 100(9), 1961–1966. Available from http://onlinelibrary.wiley.com/doi/10.1002/cncr.20184/pdf.CrossRefGoogle ScholarPubMed
Seoul National Univeristy Hospital (2013). Press release: Most life-sustaining treatment decision making done 1-week prior to death [in Korean]. Available from http://www.snuh.org/pub/snuh/sub02/sub01/1182788_3957.jsp.Google Scholar
Sleeman, K.E. (2013). End-of-life communication: Let's talk about death. The Journal of the Royal College of Physicians of Edinburgh, 43(3), 197–199. Available from http://www.rcpe.ac.uk/sites/default/files/Sleeman.pdf.Google Scholar
Sudore, R.L. & Fried, T.R. (2010). Redefining the “planning” in advance care planning: Preparing for end-of-life decision making. Annals of Internal Medicine, 153(4), 256–261. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935810/.Google Scholar
Sudore, R.L., Schillinger, D., Knight, S.J., et al. (2010). Uncertainty about advance care planning treatment preferences among diverse older adults. Journal of Health Communication, 15(Suppl. 2), 159–171.Google Scholar
Tang, S.T., Liu, T.W., Lai, M.S., et al. (2005). Concordance of preferences for end-of-life care between terminally ill cancer patients and their family caregivers in Taiwan. Journal of Pain and Symptom Management, 30(6), 510–518. Available from http://www.jpsmjournal.com/article/S0885-3924(05)00541-5/pdf.CrossRefGoogle ScholarPubMed
Thomas, K. (2011). Overview: An introduction to advance care planning. In Advance care planning in end-of-life care. Thomas, K. & Lobo, B. (eds.), pp. 3–15. New York: Oxford University Press.Google Scholar