The Characteristics of Patients in the Actively Dying Phase by Documenting the Implementation of Decisions on Life-sustaining Treatment

Abstract

Background: In recent years, Korean society has faced an increase in the elderly population owing to the advances in medical technology. This phenomenon led to the enactment of the Korean POLST and the Implementation of Decisions on Life-sustaining Treatment, which allowed discontinuation of life-sustaining treatments only after the patient is in the actively dying phase. There are two ways to enforce the law: withdrawing or withholding the treatment. However, little has been studied about the factors related to decision to withdraw or withhold the treatment. Therefore, we examined the characteristics of patients in the actively dying phase at a tertiary teaching hospital. Methods: We examined 141 actively dying patients from September to December 2018, whose life-sustaining treatment was withheld and 28 patients whose life-sustaining treatment was withdrawn. We studied the baseline and clinical characteristics of the patients by performing binary logistic regression for a multivariate analysis. Results: The mean length of survival for the patients whose treatments were withdrawn was 2.12 days and for those whose treatment was withheld was 8.95 days. The multivariate analysis showed that the patients who received the inotropic prescription were more likely to have their life-sustaining treatment withdrawn than withheld. Conclusion: The large variation in the length of survival of actively dying patients indicates the difficulty in predicting how much time one has left. Therefore, it is important for physicians and family members to understand and discuss the expected change in length of survival when making a decision to withdraw or withhold treatment.