Lee Ye Jin, Ahn Soyeon, Cho Jun Yeun, Park Tae Yun, Yun Seo Young, Kim Junghyun, Kim Jee-Min, Lee Jinwoo, Lee Sang-Min, Park Jong Sun, Cho Young-Jae, Yoon Ho Il, Lee Jae Ho, Lee Choon-Taek, Lee Yeon Joo
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Intensive Care Med. 2022 Mar;48(3):281-289. doi: 10.1007/s00134-021-06597-7. Epub 2022 Jan 1.
The importance of dying with dignity in the intensive care unit (ICU) has been emphasized. The South Korean government implemented the "well-dying law" in 2018, which enables patients to refuse futile life-sustaining treatment (LST) after being determined as terminally ill. We aimed to study whether the well-dying law is associated with a significant change in the quality of death in the ICU.
The Quality of Dying and Death (QODD) questionnaires were prospectively collected from the doctors and nurses of deceased patients of four South Korean medical ICUs after the law was passed (January 2019 to May 2020). Results were compared with those of our previous study, which used the same metric before the law was passed (June 2016 to May 2017). We compared baseline characteristics of the deceased patients, enrolled staff, QODD scores, and staff opinions about withdrawing LST from before to after the law was passed.
After the well-dying law was passed, deceased patients (N = 252) were slightly older (68.6 vs. 66.6, p = 0.03) and fewer patients were admitted to the ICU for post-resuscitation care (10.3% vs. 20%, p = 0.003). The mean total QODD score significantly increased after the law was passed (36.9 vs. 31.3, p = 0.001). The law had a positive independent association with the increased QODD score in a multiple regression analysis.
Our study is the first to show that implementing the well-dying law is associated with quality of death in the ICU, although the quality of death in South Korea remains relatively low and should be further improved.
重症监护病房（ICU）尊严死的重要性已得到强调。韩国政府于2018年实施了“善终法”，该法律使患者在被判定为绝症后能够拒绝无效的生命维持治疗（LST）。我们旨在研究善终法是否与ICU死亡质量的显著变化相关。
在该法律通过后（2019年1月至2020年5月），前瞻性地收集了韩国四家医疗ICU中死亡患者的医生和护士的死亡与临终质量（QODD）问卷。将结果与我们之前的研究进行比较，之前的研究在该法律通过前（2016年6月至2017年5月）使用了相同的指标。我们比较了法律通过前后死亡患者的基线特征、参与的工作人员、QODD评分以及工作人员关于停止生命维持治疗的意见。
善终法通过后，死亡患者（N = 252）年龄稍大（68.6岁对66.6岁，p = 0.03），因复苏后护理入住ICU的患者较少（10.3%对20%，p = 0.003）。法律通过后，QODD总平均分显著提高（36.9对31.3，p = 0.001）。在多元回归分析中，该法律与QODD评分增加呈正独立关联。
我们的研究首次表明，实施善终法与ICU的死亡质量相关，尽管韩国的死亡质量仍然相对较低，应进一步改善。
