Life-Sustaining Treatment Decision in Palliative Care Based on Electronic Health Records Analysis

Abstract

Aims and objectives: This study sought to explore the present status of life-sustaining treatment decisions in a tertiary hospital to improve the life-sustaining treatment decision-making process.

Background: Life-sustaining treatment decisions are crucial for palliative care because they encompass decisions to withdraw treatments when patients cannot articulate their values and preferences. However, surrogate decisions have settled many life-sustaining treatment cases in South Korea, and this trend is prevalent.

Design: We conducted a retrospective, descriptive study employing a review of electronic health records.

Methods: We extracted and analysed electronic health records of a tertiary hospital. Our inclusion criteria included adult patients who completed life-sustaining treatment forms in 2019. A total of 2,721 patients were included in the analysis. We analysed the decision-maker, the timing of the decision, and patients' health status a week before the decision. We followed the STROBE checklist.

Results: Among 1,429 deceased patients, those whose families had made life-sustaining treatment decisions totalled 1,028 (70.6%). The median interval between life-sustaining treatment documentation completion to death was three days, more specifically, two days in the family decision group and 5.5 days in the patient decision group. As the decision day neared, there were marked changes in patients' vital signs and laboratory test results, and the need for nursing care increased.

Conclusions: Life-sustaining treatment decisions were made when death was imminent, suggesting that the time required to discuss end-of-life care was generally insufficient among patients, family, and healthcare professionals in Korea.

Relevance to clinical practice: Monitoring changes in laboratory test results and symptoms could help screen the patients who need the life-sustaining treatment discussion. As improving the quality of death is imperative in palliative care, institutional efforts, such as clinical ethics support services, are necessary to improve the life-sustaining treatment decision-making process for patients, families, and healthcare providers.

Keywords: decision-making; electronic health records; life-sustaining treatment; palliative care; terminal care.