Factors Affecting Life-Sustaining Treatment Decisions and Changes in Clinical Practice after Enforcement of the Life-Sustaining Treatment Decision (LST) Act: A Tertiary Hospital Experience in Korea

In Korea, the act on hospice and palliative care and decisions on life-sustaining treatment (LST) was implemented on February 4, 2018.We aimed to investigate relevant factors and clinical changes associated with LST decisions after law enforcement. Materials and MethodsThis single-center retrospective study included patients who completed LST documents using legal forms at Asan Medical Center from February 5, 2018, to June 30, 2020. Results5896 patients completed LST documents, of which 2704 (45.8%) signed the documents in person, while family members of 3,192 (54%) wrote the documents on behalf of the patients.Comparing first year and following year of implementation of the act, the self-documentation rate increased (43.9% to 47.2%, p=0.014).Moreover, the number of LST decisions made during or after ICU admission decreased (37.8% vs. 35.2%,p=0.045), and the completion rate of LST documents during chemotherapy increased (6.6% vs. 8.9%, p=0.001).In multivariate analysis, age < 65 (OR, 1.724; 95% CI, 1.538-1.933;p<0.001), unmarried status (OR, 1.309; 95% CI, 1.097-1.561;p=0.003), palliative care consultation (OR, 1.538; 95% CI, 1.340-1.765;p<0.001), malignancy (OR, 1.864; 95% CI, 1.628-2.133;p<0.001), and changes in timing on the first year versus following year (OR, 1.124, 95% CI, 1.003-1.260,p=0.045) were related to a higher selfdocumentation rate. ConclusionAge < 65, unmarried status, malignancy, and referral to a palliative care team were associated with patients making LST decisions themselves.Furthermore, the subject and timing of LST decisions have changed with the LST act.