Completion rate of Physician Orders for Life-Sustaining Treatment for patients with metastatic or recurrent cancer: A cross-sectional study
Background: “End of life” is a difficult topic of conversation in East Asian cultures, even among patients and doctors who share a good rapport. In 2016, the Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, which took the form of “Physician Orders for Life-Sustaining Treatment,” was introduced in South Korea. This study was conducted to investigate the completion rate of Physician Orders for Life-Sustaining Treatment in patients with advanced cancer on the active recommendation of physicians, as well as patients’ general attitudes toward end-of-life care.
Methods: We conducted a cross-sectional descriptive survey on patients with advanced cancer. A total of 101 patients with advanced solid cancer agreed to participate in the study. The primary endpoint was the rate of completion of Physician Orders for Life-Sustaining Treatment based on a doctor’s suggestion. Written interviews were conducted to understand the perceptions and factors influencing patients’ decisions.
Results: Of the 101 patients, 72 (71.3%) agreed to prepare Physician Orders for Life-Sustaining Treatment. Patients who had an educational level of high school or higher were more likely to agree to complete Physician Orders for Life-Sustaining Treatment documentation as compared to the lower educational status group. More than half of the respondents who completed Physician Orders for Life-Sustaining Treatment documentation reported that they had more than a fair understanding of “life-sustaining care” or “Physician Orders for Life-Sustaining Treatment.” Participants’ reasons for Physician Orders for Life-Sustaining Treatment completion were diverse.
Conclusions: We found that highly educated patients, who understood the concept behind the policy well, tended to accept Physician Orders for Life-Sustaining Treatment without hesitation. Better education, information shared through the media, and conversations with health care providers might improve understanding of Physician Orders for Life-Sustaining Treatment in patients with cancer.
Figure 1. Schematic representation of the study population.
Figure 2. POLST completion rate and reasons for completing or declining to complete
POLST. The total POLST completion rate was 71.3%. A larger area is indicative of a
higher response rate. “To exercise my own will, not that of my caregiver” was the
most popular reason for completing POLST, and “need to discuss it further with family”
was the most common reason for declining POLST.
Supplementary table 1. Responses to questions about end-of-life care
3 more questions and responses from participants for the general end-of-life care.
Supplementary Figure 1. The relationship of advance care planning (ACP) with advance
directives (AD) and Physician Orders for Life-Sustaining Treatment (POLST).
A diagram about the concept of advance care and related documents.
Supplement survey questionnaire : Awareness and attitudes of patients with cancer
toward physician orders for life-sustaining treatment(POLST)
A sample questionnaire form which was used for the study.