Yoo SH, et al. J Korean Med Sci. 2023 May;38(24):e182. https://doi.org/10.3346/jkms.2023.38.e182

The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life (ELDA) was passed by the Korean National Assembly in 2016 and came into effect in 2018. Although the stated purpose of the act is to uphold patient autonomy and dignity in the context of end-of-life (EOL) care, its utilization remains low, with only some 40% of EOL decisions reflecting patients’ direct opinions. This study aims to pinpoint areas for enhancing ELDA by comparing it with similar systems in other countries and gathering expert opinions. To achieve this, we reviewed ELDA, compared it with EOL care systems in Taiwan, Japan, the UK, the US, and Germany, and surveyed Korean medical experts to collect their thoughts on how ELDA might be improved. On this basis, we make several recommendations, including broadening the scope of ELDA, bolstering the role of advance directives, and providing education for healthcare professionals. These recommendations are expected to increase the utilization rate of ELDA and enhance the quality of EOL care in South Korea.

Yejin Kim, M.S.W., Shin Hye Yoo, M.D., Ph.D, Jeong Mi Shin, M.D., Hyoung Suk Han, R.N., Jinui Hong, R.N., Hyun Jee Kim, M.S.W., Wonho Choi, R.N., Min Sun Kim, M.D., Hye Yoon Park, M.D., Ph.D. and Bhumsuk Keam, M.D., Ph.D.. Korean J Hosp Palliat Care 2021;24:130-4. https://doi.org/10.14475/jhpc.2021.24.2.130

Respecting the preference for a place of care is essential for advance care planning in patients with advanced cancer. This retrospective study included adult patients with cancer referred to an inpatient palliative care consultation team at a tertiary acute care hospital in South Korea between April 2019 and December 2020. Patients’ preference for place of care and demographic and clinical factors were recorded, and the actual discharge locations were categorized as home or non-home. Patients discharged home but with unintended hospital visits within 2 months were also investigated. Of the 891 patients referred to the palliative care consultation team, 210 (23.6%) preferred to be discharged home. Among them, 113 (53.8%) were discharged home. No significant differences were found between patients who preferred home discharge and those who did not. Home discharge was higher among female patients (p = 0.04) and lower in those with poor oral intake (p < 0.001) or dyspnea (p = 0.02). Of the 113 patients discharged home, 37 (32.8%) had unintended hospital visits within 2 months. Approximately one-quarter of hospitalized patients with advanced cancer preferred to be discharged home, but only half of them received the home discharge. To meet patients’ preferences for end-of-life care, individual care planning considering relevant factors is necessary.

In Korea, since the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life was implemented in February 2018, advance directives (ADs) have become legally effective and should be documented after sufficient explanation by a registered counselor. However, little is known regarding the adequacy of current AD counseling. This qualitative study aimed to explore the barriers to AD counseling based on counselors’ experiences. We conducted focus group interviews using purposive sampling. Seven counselors working at hospitals, community health institutions, and non-profit organizations participated in this study. They were asked about the challenges and problems they encountered during AD counseling. Three themes emerged from this study; 1) issues regarding consistency in AD counseling, 2) issues regarding AD counselors’ competency and work environment, and 3) issues regarding the adequacy of the service system. The interviewees stated that the lack of a manual for standardized service made AD counseling inconsistent. The limited competency and poor work environment of counselors were pointed out as major barriers. The interviewees also stated that a proper service system considering individual circumstances is absent. The goals of AD counseling should be clarified and guidance should be implemented for providing standardized services. Further efforts to enhance the competency of AD counselors and to improve their working conditions are needed. Establishing an integrated framework for an adequate service system is also essential to overcome systematic barriers to AD counseling.

This paper examines the practical challenges of respecting patient autonomy in life-sustaining treatment (LST) decisions through a real clinical case. While Korea’s Life-Sustaining Treatment Decision Act provides a legal framework for withholding and withdrawing LST, its implementation in clinical settings remains complex. This case study illustrates the intricate decision-making dynamics among patients, healthcare providers, and caregivers, highlighting the need for more nuanced ethical deliberation in Advance Care Planning (ACP). The absence of ACP that fully reflects patients’ preferences and values can hinder optimal end-of-life care. This study argues for a more practical approach to balancing patient autonomy and best interests, offering recommendations to enhance ACP integration in clinical practice.