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Factors Influencing Life-Sustaining Treatment Decision and the Healthcare Utilization before Death for Patients
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연명의료결정법 대상 환자의 연명의료결정과사망 전 의료이용에의 영향요인

논문 기본 정보

Type
Academic journal
Author
Kim, Myung Ok (가톨릭대학교 서울성모병원) Park, Myung Hee (가톨릭대학교 서울성모병원) Han, Ji Hee (가톨릭대학교 서울성모병원) Kim, Jin Joo (가톨릭대학교 서울성모병원) Jang, Ji Min (가톨릭대학교 서울성모병원)
Journal
가톨릭대학교(성의교정) 가톨릭생명윤리연구소 인격주의 생명윤리 인격주의 생명윤리 제14권 제1호 KCI Accredited Journals
Published
2024.1
Pages
35 - 68 (34page)

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Factors Influencing Life-Sustaining Treatment Decision and the Healthcare Utilization before Death for Patients
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This study embarks on a detailed cohort analysis to identify the factors influencing life-sustaining treatment (LST) decisions and healthcare usage before death. Utilizing multinomial logistic regression, it examines a diverse sample of 1,072 patients, categorized into three groups: self-determination, family determination, and DNR. The majority of the cohort, 49.4%, falls under the self-determination group, with a significant proportion of patients (92.8%) suffering from cancer. We find that the most common medical intervention in the week preceding death was blood transfusions, accounting for 49.2% of cases. The study reveals that the self-determination group experienced lower daily healthcare costs, higher hospice utilization rates, and longer intervals between physician orders for life-sustaining treatment(POLST) or DNR completion and death, compared to the other groups. Moreover, patients with stupor on admission were significantly more likely to be in the family determination group (36.225 times) or the DNR group (19.422 times) than in the self-determination group. Furthermore, the likelihood of ICU use was higher in the family determination (3.627 times) and DNR groups (4.137 times), with the application of mechanical ventilation being 2.372 times more common in the family determination group and 4.209 times in the DNR group. Lastly, cardiopulmonary resuscitation was 9.122 times more prevalent in the DNR group compared to the self-determination group. The study concludes that self-determination in LST can significantly reduce unnecessary healthcare utilization before death and promote hospice care utilization, underscoring the necessity of supporting patients in planning their end-of-life care, including decisions about LST.
#연명의료 #연명의료계획서 #의료이용 #호스피스 #Life-Sustaining Treatment #Physician Orders for Life-Sustaining Treatment(POLST) #Healthcare Utilization #Hospice& #Palliative Care

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