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5 "palliative care"
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Original Articles
Ethics
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
Acute Crit Care. 2024;39(2):294-303.   Published online May 24, 2024
DOI: https://doi.org/10.4266/acc.2023.01130
  • 544 View
  • 78 Download
AbstractAbstract PDFSupplementary Material
Background
The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.
Nursing
Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan
Khaldoun Mohammad Hamdan, Ahmad M. Al-Bashaireh, Mohammad Al-Dalahmeh, Ahmad Rajeh Saifan, Maha Alkaid Albqoor, Abeer M. Shaheen
Acute Crit Care. 2023;38(4):469-478.   Published online November 28, 2023
DOI: https://doi.org/10.4266/acc.2023.00430
  • 1,949 View
  • 105 Download
AbstractAbstract PDF
Background
There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study’s purpose was to examine nurses’ knowledge and attitudes toward palliative care.
Methods
A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data.
Results
We measured nurses’ knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type.
Conclusions
ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.
Review Article
Basic science and research
Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review
Christantie Effendy, Yodang Yodang, Sarah Amalia, Erna Rochmawati
Acute Crit Care. 2022;37(4):516-526.   Published online October 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00745
  • 4,982 View
  • 353 Download
  • 4 Web of Science
  • 6 Crossref
AbstractAbstract PDF
The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

Citations

Citations to this article as recorded by  
  • A necessidade dos cuidados paliativos na Unidade de Terapia Intensiva (UTI)
    Larissa Kênia de Oliveira Barros Dos Santos, Isabella Rodrigues Ribeiro, João Pedro Manduca Ferreira, Victor Hugo Oliveira Moraes, Érika Aguiar Lara Pereira
    Cuadernos de Educación y Desarrollo.2024;[Epub]     CrossRef
  • End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
    Andrea Cortegiani, Mariachiara Ippolito, Sebastiano Mercadante
    Anesthesiology Clinics.2024; 42(3): 407.     CrossRef
  • What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review
    Nabat Almalki, Breidge Boyle, Peter O’Halloran
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer
    Irene Giannubilo, Linda Battistuzzi, Eva Blondeaux, Tommaso Ruelle, Francesca Benedetta Poggio, Giulia Buzzatti, Alessia D’Alonzo, Federica Della Rovere, Maria Maddalena Latocca, Chiara Molinelli, Maria Grazia Razeti, Simone Nardin, Luca Arecco, Marta Per
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Palliative Care in the Intensive Care Unit: The Standard of Care
    Clareen Wiencek
    AACN Advanced Critical Care.2024; 35(2): 112.     CrossRef
  • Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotlan
    Satyajit Ray, Emma Victoria McLorie, Jonathan Downie
    Healthcare.2023; 11(17): 2438.     CrossRef
Review
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean J Crit Care Med. 2013;28(3):163-172.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.163
  • 3,616 View
  • 161 Download
  • 8 Crossref
AbstractAbstract PDF
The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient's autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient's death in imminent. To improve understanding EOL care of terminally ill patients, we summarize 'Recommendations for EOL care in the ICU by the American College of Critical Care Medicine' and 'Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science'. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

Citations

Citations to this article as recorded by  
  • A Scoping Review of End-Of-Life Care Education Programs for Critical Care Nurses
    Eugene HAN, Sumi CHOI, Ki Young YUN, Sung Ha KIM, Sanghee KIM, Hye Young YUN
    Korean Journal of Medical Ethics.2023; 26(3): 185.     CrossRef
  • Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards
    Nan Song, Ja Yun Choi
    Asian Oncology Nursing.2020; 20(1): 10.     CrossRef
  • Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction
    Kkot Bi Jeon, Mihyun Park
    Journal of Korean Academy of Nursing Administration.2019; 25(1): 42.     CrossRef
  • Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study
    Hyun Sook Kim, Eun Kyoung Choi, Tae Hee Kim, Hye Young Yun, Eun Ji Kim, Jin Ju Hong, Jeong A Hong, Geon Ah Kim, R.N. Sung Ha Kim
    The Korean Journal of Hospice and Palliative Care.2019; 22(2): 87.     CrossRef
  • Factors Influencing Performance of End-of-life Care by ICU Nurses
    Mun Jung Ko, So-Hyun Moon
    Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 327.     CrossRef
  • Development of an Electronic Document for DNR Informed Consent based on the Electronic Medical Record System
    Ji-Kyeong Park
    The Korean Journal of Health Service Management.2016; 10(3): 99.     CrossRef
  • Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
    Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
    The Korean Journal of Critical Care Medicine.2015; 30(2): 73.     CrossRef
  • Application of Animation Mobile Electronic Informed Consent in Inpatient of Long-term Care Hospital: Focused on DNR Informed Consent
    Ji-Kyeong Park, Ji-On Kim
    Journal of Digital Convergence.2015; 13(11): 187.     CrossRef
Original Article
A Survey of Patients Who Were Admitted for Life-Sustaining Therapy in Nationwide Medical Institutions
Jong Myon Bae, Joo Young Gong, Jae Ran Lee, Dae Seog Heo, Younsuck Koh
Korean J Crit Care Med. 2010;25(1):16-20.
DOI: https://doi.org/10.4266/kjccm.2010.25.1.16
  • 3,215 View
  • 59 Download
  • 16 Crossref
AbstractAbstract PDF
BACKGROUND
The study focused on figuring out the present status and distribution of the underlying diseases of Korean terminally ill patients (TIP) who were on life-support care (LSC) by conducting a nationwide health care survey.
METHODS
The authors of this study requested that the 308 nationwide hospitals that operate intensive care units answer a questionnaire that asked about the number of admitted TIPs and their underlying diseases at 12 Am, 22 July, 2009. The proportion of TIPs among all the admitted patients and the percentages of the TIP's underlying diseases were calculated.
RESULTS
In a total of 83.1% of the eligible hospitals responded, the proportion of TIP was 1.6 of 100 admitted patients. Terminal cancer was the leading underlying disease in the TIPs (42.4%). Five % of the patients on LSC were brain dead. More TIPs were admitted in the national/public or university hospitals than in the private or non-university hospitals.
CONCLUSIONS
Futile treatment seems to be administered to the TIPs in Korean hospitals. The quality of terminal care in Korean hospitals should be improved by the application of socially acceptable LSC guidelines. Timely government health plans, including hospice care, to improve the quality of palliative care should be launched and maintained.

Citations

Citations to this article as recorded by  
  • Attitudes, Perceptions, and Experiences toward End-of-Life Care Decision-Making among Intensive Care Unit Nurses in Korea : An Integrative Review
    JiYeon Choi, Youn-Jung Son, Kyounghoon Lee
    Journal of Korean Critical Care Nursing.2020; 13(1): 27.     CrossRef
  • Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
    Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Acute and Critical Care.2018; 33(2): 95.     CrossRef
  • A literature review on end-of-life care among Korean Americans
    Hye-young K Park, Cristina C Hendrix
    International Journal of Palliative Nursing.2018; 24(9): 452.     CrossRef
  • Attitude, Role Perception and Nursing Stress on Life Sustaining Treatment among Intensive Care Unit Nurses
    Su Jeong Lee, Hye Young Kim
    Korean Journal of Adult Nursing.2017; 29(2): 131.     CrossRef
  • End‐of‐life communication in Korean older adults: With focus on advance care planning and advance directives
    Dong Wook Shin, Ji Eun Lee, BeLong Cho, Sang Ho Yoo, SangYun Kim, Jun‐Hyun Yoo
    Geriatrics & Gerontology International.2016; 16(4): 407.     CrossRef
  • The Current Status of End-of-Life Care in Korea and Legislation of Well-Dying Act
    Ji Eun Lee, Ae Jin Goo, Be Long Cho
    Journal of the Korean Geriatrics Society.2016; 20(2): 65.     CrossRef
  • The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
  • Comparing the Preference for Terminal Care in Nurses and Patients
    Dong Soon Kim, AeYoung So, Kyung-Sook Lee, Jung Sook Choi
    Journal of muscle and joint health.2013; 20(3): 214.     CrossRef
  • Life-Sustaining Medical Treatment for Terminal Patients in Korea
    Dae Seog Heo
    Journal of Korean Medical Science.2013; 28(1): 1.     CrossRef
  • The End-of-Life Care in the Intensive Care Unit
    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
  • Factors Affecting Shared Decision Making at End of Life in Korean Adults
    Jo Kae-Hwa, An Gyeong-Ju
    Holistic Nursing Practice.2013; 27(6): 329.     CrossRef
  • On the life-sustaining treatment in Korea
    Yoon-seong Lee
    Journal of the Korean Medical Association.2012; 55(12): 1161.     CrossRef
  • Current status of end-of-life care in Korean hospitals
    Younsuck Koh
    Journal of the Korean Medical Association.2012; 55(12): 1171.     CrossRef
  • Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
    Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
    Korean Journal of Critical Care Medicine.2012; 27(1): 16.     CrossRef
  • Predictive Factor s for City Dweller s’ Attitudes toward Death with Dignity
    Kae Hwa Jo, Gyeong Ju An, Gyun Moo Kim, Yeon Ja Kim
    The Korean Journal of Hospice and Palliative Care.2012; 15(4): 193.     CrossRef
  • Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy
    Younsuck Koh, Dae-Seog Heo, Young Ho Yun, Jeong-Lim Moon, Hyoung Wook Park, Ji Tae Choung, Hyo Sung Jung, Bark Jang Byun, Yoon-Seong Lee
    Journal of the Korean Medical Association.2011; 54(7): 747.     CrossRef

ACC : Acute and Critical Care