• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.198-206
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• 2019

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward. Methods: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital. Results: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MK-POLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation. Conclusion: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients.

• Journal of Hospice and Palliative Care
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• v.12 no.1
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• pp.20-26
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• 2009

Purpose: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. Methods: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. Results: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. Conclusion: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.232-237
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• 2004

Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.