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Purpose: This descriptive correlation study was done to investigate the influence of older person's ego integrity and knowledge of advance directives on their attitude toward withdrawal from life-sustaining treatment. Methods: The participants were 155 older persons residing in B city. Data were collected from February 11 to March 8, 2019. Data analysis was performed using descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficient, and stepwise multiple regression analysis. Results: Ego integrity was positively correlated with knowledge of advance directives and attitude toward withdrawal from life-sustaining treatment. Knowledge of advance directives was positively correlated with attitude toward withdrawal from life-sustaining treatment. The factors influencing attitude toward withdrawal from life-sustaining treatment were participants' economic status, ego-integrity and knowledge of advance directives. These variables explained 17.1% of older person's attitude toward withdrawal from life-sustaining treatment. Conclusion: The findings indicate that ego integrity and knowledge of advance directives are important factors in changing older people's attitude toward withdrawal from life-sustaining treatment. Therefore, systematic programs to enhance the older person's ego integrity level and improve their knowledge of advance directives should be developed. [ABSTRACT FROM AUTHOR]

Hospice and palliative care can help terminal patients and their family members to face the natural end of life more comfortably, by providing them with an environment to address psychosocial and spiritual problems, as well as physical symptoms. However, most patients and their caregivers have the misconception that hospice care means the withdrawal of all treatments. Many physicians also consider hospice care to be a form of terminal care after all treatments are finished. Laws regulating the withdrawal of life-prolonging treatment came into effect in Korea in 2018, and these regulations also apply to most terminal stages of benign diseases. The withdrawal of futile lifeprolonging treatment is quite different from euthanasia or negligence. At the last stage of disease, treatment aimed at alleviating various symptoms can make critically ill patients more comfortable and thereby help them to die with dignity. Patients with a terminal illness should receive hospice and palliative care, instead of futile life-prolonging treatment. Therefore, education and training programs to promote a proper understanding of hospice and palliative care should be considered mandatory. [ABSTRACT FROM AUTHOR]

It is natural for all human beings to die; hence, death is an inevitable event. However, advances in medical technology are changing the meaning of natural death. These advanced treatments provide the capability to intervene at the time of death and to reshape the circumstances around natural death, by sustaining human life. However, it is extremely difficult to judge when treatment is futile for the patient's best interests. It is therefore recommended to make time to discuss the concept of medical futility during the course of caring for a critically ill patient. Despite the expectations and efforts of the patient, the patient's family, and medical staff, the patient will eventually, have a 'hopeless' medical condition. Most discussions about decision-making in end-of-life treatment have neen ethical debates focused on the patient's self-determination and best interest in the context of concepts such as euthanasia or death with dignity. However, such discussions are insufficient for resolving the wide variety of circumstances that occur in clinical settings. Instead, the various ethical dilemmas inherent to end-of-life care should be approached by educating medical teams, patients, and their families about how to recognize medical futility. Furthermore, it is important to optimize the balance between the rights of patients and the responsibility of physicians. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). Methods: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. Results: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient’s loss of decision-making capacity. Decisions were made most frequently by the patient’s son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). Conclusions: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

Purpose: The purpose of this study was to examine the mediation of Self-Esteem in the relationship between Social Support and attitude toward the Withdrawal of Life-Sustaining Treatment (WLST) for community dwelling elderly in order to provide a basis for planning nursing interventions to improve the attitude of elderly. Methods: The participants were 252 elderly residing in Seoul. The data were collected through a questionnaire survey distributed in March, 2016. The survey included scales on Social Support, attitude towards WLST and measures of Self-esteem. Collected data were analyzed using SPSS/WIN 21.0 program. Results: The mean score for the attitude towards WLST was 73.83. Self-Esteem was 29.44. Overall Social Support was 42.51. There were significant correlations among the three variables. Self-esteem was directly affected by the attitude (R2 =24%). Attitude towards WLST was directly affected by Family Support. Family Support and Self-esteem affected by the attitude on WLST (R2 =19%). Self-esteem had a partial mediating effect (β=.23, p<.001) in the relationship between Family Support and reported attitude from the WLST (Sobel test: Z=4.93, p<.001). Conclusion: Based on the findings of this study, programs can be created focusing on Social Support and Self-Esteem improvement. The programs may positively change the elderly's attitude towards WLST. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. Methods: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi’s phenomenological research methodology. Results: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: “agony and conflict in the aspects of care”, “heavy mind and regret for exhausting care”, “intentionally avoiding parents’ sadness”, “comforting sadness in the heart” and “orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment.” Conclusion: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses. [ABSTRACT FROM AUTHOR]

Advanced incurable cancer patients receive palliative chemotherapy to prolong their life and improve quality of life. However, physicians should assess the timing to discontinue the treatment, especially near the final months of life, as palliative chemotherapy may accompany considerable toxicity. Even though there are no clear guidelines regarding the withdrawal timing for anticancer treatment in palliative setting, it is important clarify the issue for quality of care for advanced cancer patients. Here, we present two patients who received palliative chemotherapy for advanced colon cancer and non-small cell lung cancer, respectively. In both cases, it was jointly determined to stop palliative chemotherapy, and best efforts are made to relieve troublesome symptoms. The cases and upto-date literature review will highlight the importance of the timing of discontinuation of cancer treatments when changes are being made to the health care system and hospice and palliative medicine is taking root in Korea. [ABSTRACT FROM AUTHOR]

Purpose: This study identified the reasons why tuberculosis (TB) patients withhold treatment in a bid to develop a assessment scale to select patients who needs nursing intervention in the early stage and decrease the risk of discontinuation of treatment. Sample: There were two samples. A sample of 191 patients with TB and having primary treatment and a second sample of N who were under re-treatment Methods: The study design included qualitative and quantitative methods. Qualitative data were collected from in-depth interviews of TB patients under re-treatment. The quantitative data were collected from 191 patients with TB under primary treatment. Results: Exploratory factor analysis revealed 11 factors explaining 69.6% of total variance. These factors were categorized into four subgroups. A depression scale was used to establish concurrent validity. The depression scale had a positive relationship (r=54) with the discontinuing of primary treatment. The internal consistency reliability for the four subgroups was over .84. The confidence coefficient was Cronbach's ⍺ .95. The final scale was a self-reported four Likert scale including 50 items. Conclusion: Reliability and validity was established for the scale and the scale can be used to examine the risk of treatment discontinuation for TB. The scale is an important resource for nursing interventions in identifying and treating high risk clients. [ABSTRACT FROM AUTHOR]

The development of life sustaining treatment technology including artificial ventilation has given us the moral problem, considering the human dignity and futility of medical treatment, until when these treatments could be given to terminally ill patients. In Korea, there were two supreme court decisions a significant impacts on the withdrawal of life sustaining treatment. After these decisions, Korean medical society has developed a guideline for advance directives and has also established a voluntary hospital ethics committee. The patient's right of self- determination right and the paternalistic approach of medicine should be balanced at an optimal level, because benefits of medical advances should be adjusted to take into account the burden of life prolongations. Decision making always has been difficult because related to ethical values, and there a broad spectrum of value-laden attitudes within Korean society. The legalization of end-of-life care should be from the respect of the professional autonomy of medical society. Under these considerations, we should supply alternative methods like hospice care, which can help to manage the withdrawal of life support appropriately, and also make an effort to relieve the economical burden of patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines. Methods: The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers. Results: 75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying. Conclusions: In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to categorize adult's subjectivity of their attitudes towards life sustaining treatment, and thereby understand the differences among these life sustaining treatment types using Q methodology., Methods: Q-methodology, which provides a method of analyzing the subjectivity of each item, was used. Thirty selected Q-statements received from 52 adults were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL pc program., Result: Four types of attitudes toward life sustaining treatment were identified. Type I is called one's autonomy type. Type II is called potentiality of resuscitation type. Type III is called DNR (Do not resuscitation) type. Type IV is calledone's effort type., Conclusion: The results of the study indicate that different approaches of life support care programs are recommended based on the four types of life sustaining treatment attitudes among Korean adults.