Kong Bong Han, An Ho Jung, Kim Hyun Seon, Ha So-Young, Kim Il-Kyu, Lee Jung Eun, Park Youn Jung, Kang Yi-Jin, Kim Young Rye, Kim Hoon-Kyo
Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. ; Hospice Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Hospice Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
J Korean Med Sci. 2015 Feb;30(2):151-4. doi: 10.3346/jkms.2015.30.2.151. Epub 2015 Jan 21.
To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.
为在面对死亡时保护患者自主权，生前预嘱（ADs）的重要性近来已成为一个问题，并在韩国逐渐被接受。然而，在实际操作中，大多数情况下生前预嘱并非由患者本人而是由其家属完成。为分析生前预嘱的执行现状，我们回顾了2012年10月至2013年9月入住临终关怀中心的214例晚期癌症患者的病历。76例（35.5%）患者完成了生前预嘱。所有生前预嘱均由患者本人完成。未完成生前预嘱的最常见原因是身体和/或精神状况不佳。作为代理人，大多数患者选择其配偶（55.3%）。很少有患者希望接受维持生命治疗（1.3%），然而89.5%的患者接受姑息性镇静。入院后生前预嘱的中位时间为3（0 - 90）天，生前预嘱后的生存时间为22（1 - 340）天。总之，约三分之一的晚期癌症患者自行完成了生前预嘱。考虑到患者状况不佳是未完成生前预嘱的主要原因，有必要更早地讨论生前预嘱以提高患者的参与度。
