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연명의료중단등결정 이행서를 통해 본 임종기 환자의 특성

The Characteristics of Patients in the Actively Dying Phase by Documenting the Implementation of Decisions on Life-sustaining Treatment

임상노인의학회지 2020년 21권 2호 p.103 ~ 109
신진, 이청우, 최윤선, 김선미, 박홍석, 박석원, 모은식, 박재현, 이현진, 정성윤,
소속 상세정보
신진 ( Shin Jean ) - Korea University Guro Hospital Department of Family Medicine
이청우 ( Lee Chung-Woo ) - Korea University Guro Hospital Department of Family Medicine
최윤선 ( Choi Youn-Seon ) - Korea University Guro Hospital Department of Family Medicine
김선미 ( Kim Seon-Mee ) - Korea University Guro Hospital Department of Family Medicine
박홍석 ( Park Hong-Seok ) - Korea University Guro Hospital Department of Urology
박석원 ( Park Seok-Won ) - Korea University Guro Hospital Department of Family Medicine
모은식 ( Mo Eun-Shik ) - Korea University Guro Hospital Department of Family Medicine
박재현 ( Park Jae-Hyun ) - Korea University Guro Hospital Department of Family Medicine
이현진 ( Lee Hyun-Jin ) - Korea University Guro Hospital Department of Family Medicine
정성윤 ( Joung Sung-Yoon ) - Korea University Guro Hospital Department of Family Medicine

Abstract


Background: In recent years, Korean society has faced an increase in the elderly population owing to the advances in medical technology. This phenomenon led to the enactment of the Korean POLST and the Implementation of Decisions on Life-sustaining Treatment, which allowed discontinuation of life-sustaining treatments only after the patient is in the actively dying phase. There are two ways to enforce the law: withdrawing or withholding the treatment. However, little has been studied about the factors related to decision to withdraw or withhold the treatment. Therefore, we examined the characteristics of patients in the actively dying phase at a tertiary teaching hospital.

Methods: We examined 141 actively dying patients from September to December 2018, whose life-sustaining treatment was withheld and 28 patients whose life-sustaining treatment was withdrawn. We studied the baseline and clinical characteristics of the patients by performing binary logistic regression for a multivariate analysis.

Results: The mean length of survival for the patients whose treatments were withdrawn was 2.12 days and for those whose treatment was withheld was 8.95 days. The multivariate analysis showed that the patients who received the inotropic prescription were more likely to have their life-sustaining treatment withdrawn than withheld.

Conclusion: The large variation in the length of survival of actively dying patients indicates the difficulty in predicting how much time one has left. Therefore, it is important for physicians and family members to understand and discuss the expected change in length of survival when making a decision to withdraw or withhold treatment.

키워드

Advance directives; Life support care; Terminal care; Terminally ill

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