Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim
{"title":"生命维持治疗决定法案》实施后儿科生命终结程序的变化--一家儿童医院的经验。","authors":"Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim","doi":"10.3390/healthcare12212156","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> The Act on Life-Sustaining Treatment (LST) for patients at the end of life (the Korean LST Decision Act), implemented in the Republic of Korea in February 2018, has led to changes in the end-of-life decision-making (EOLDM) process in children. This study aimed to investigate changes in pediatric EOLDM process and LST practices since the Korean LST Decision Act. <b>Methods:</b> This retrospective cohort study included 107 patients who died at Kyungpook National University Children's Hospital from January 2015 to December 2020. Patients were divided into two groups: pre-law (January 2015-January 2018, <i>n</i> = 55) and post-law (February 2018-December 2020, <i>n</i> = 52). We analyzed medical records for EOLDM process, patient characteristics, intensive care unit (ICU) admission, documentation types, and LST withholding or withdrawal decisions. <b>Results:</b> After the Korean LST Decision Act, the median total hospitalization duration decreased significantly (14 days [IQR, 3-80] vs. 6 days [IQR, 2-18], <i>p</i> = 0.020), as did the median ICU length of stay (3 days [IQR 1-33] vs. 2.5 days [IQR 1-10.3], <i>p</i> = 0.002). The time from admission to end-of-life decision documentation was significantly shorter in group 2 (6 days [IQR 1-31] vs. 4 days [IQR 1-9], <i>p</i> = 0.027). The use of physician orders for life-sustaining treatment (POLST) documents increased (0% to 33.3%), while do-not-resuscitate (DNR) orders decreased (85.3% to 16.7%). Notably, LST withdrawal decisions increased from 0% to 27.8% (<i>p</i> = 0.001) in the post-legislation period. <b>Conclusions:</b> The Korean LST Decisions Act has led to significant changes in the EOLDM process for terminally ill children, including earlier decision-making, increased use of POLST documents, more frequent LST withdrawal decisions, and shorter hospital and ICU stays. These findings suggest a shift towards more structured and timely end-of-life care discussions in pediatric settings.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"12 21","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11545692/pdf/","citationCount":"0","resultStr":"{\"title\":\"Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions-The Experience of a Single Children's Hospital.\",\"authors\":\"Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim\",\"doi\":\"10.3390/healthcare12212156\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> The Act on Life-Sustaining Treatment (LST) for patients at the end of life (the Korean LST Decision Act), implemented in the Republic of Korea in February 2018, has led to changes in the end-of-life decision-making (EOLDM) process in children. This study aimed to investigate changes in pediatric EOLDM process and LST practices since the Korean LST Decision Act. <b>Methods:</b> This retrospective cohort study included 107 patients who died at Kyungpook National University Children's Hospital from January 2015 to December 2020. Patients were divided into two groups: pre-law (January 2015-January 2018, <i>n</i> = 55) and post-law (February 2018-December 2020, <i>n</i> = 52). We analyzed medical records for EOLDM process, patient characteristics, intensive care unit (ICU) admission, documentation types, and LST withholding or withdrawal decisions. <b>Results:</b> After the Korean LST Decision Act, the median total hospitalization duration decreased significantly (14 days [IQR, 3-80] vs. 6 days [IQR, 2-18], <i>p</i> = 0.020), as did the median ICU length of stay (3 days [IQR 1-33] vs. 2.5 days [IQR 1-10.3], <i>p</i> = 0.002). The time from admission to end-of-life decision documentation was significantly shorter in group 2 (6 days [IQR 1-31] vs. 4 days [IQR 1-9], <i>p</i> = 0.027). The use of physician orders for life-sustaining treatment (POLST) documents increased (0% to 33.3%), while do-not-resuscitate (DNR) orders decreased (85.3% to 16.7%). Notably, LST withdrawal decisions increased from 0% to 27.8% (<i>p</i> = 0.001) in the post-legislation period. <b>Conclusions:</b> The Korean LST Decisions Act has led to significant changes in the EOLDM process for terminally ill children, including earlier decision-making, increased use of POLST documents, more frequent LST withdrawal decisions, and shorter hospital and ICU stays. These findings suggest a shift towards more structured and timely end-of-life care discussions in pediatric settings.</p>\",\"PeriodicalId\":12977,\"journal\":{\"name\":\"Healthcare\",\"volume\":\"12 21\",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11545692/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Healthcare\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/healthcare12212156\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Healthcare","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/healthcare12212156","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions-The Experience of a Single Children's Hospital.
Background: The Act on Life-Sustaining Treatment (LST) for patients at the end of life (the Korean LST Decision Act), implemented in the Republic of Korea in February 2018, has led to changes in the end-of-life decision-making (EOLDM) process in children. This study aimed to investigate changes in pediatric EOLDM process and LST practices since the Korean LST Decision Act. Methods: This retrospective cohort study included 107 patients who died at Kyungpook National University Children's Hospital from January 2015 to December 2020. Patients were divided into two groups: pre-law (January 2015-January 2018, n = 55) and post-law (February 2018-December 2020, n = 52). We analyzed medical records for EOLDM process, patient characteristics, intensive care unit (ICU) admission, documentation types, and LST withholding or withdrawal decisions. Results: After the Korean LST Decision Act, the median total hospitalization duration decreased significantly (14 days [IQR, 3-80] vs. 6 days [IQR, 2-18], p = 0.020), as did the median ICU length of stay (3 days [IQR 1-33] vs. 2.5 days [IQR 1-10.3], p = 0.002). The time from admission to end-of-life decision documentation was significantly shorter in group 2 (6 days [IQR 1-31] vs. 4 days [IQR 1-9], p = 0.027). The use of physician orders for life-sustaining treatment (POLST) documents increased (0% to 33.3%), while do-not-resuscitate (DNR) orders decreased (85.3% to 16.7%). Notably, LST withdrawal decisions increased from 0% to 27.8% (p = 0.001) in the post-legislation period. Conclusions: The Korean LST Decisions Act has led to significant changes in the EOLDM process for terminally ill children, including earlier decision-making, increased use of POLST documents, more frequent LST withdrawal decisions, and shorter hospital and ICU stays. These findings suggest a shift towards more structured and timely end-of-life care discussions in pediatric settings.
期刊介绍：
Healthcare (ISSN 2227-9032) is an international, peer-reviewed, open access journal (free for readers), which publishes original theoretical and empirical work in the interdisciplinary area of all aspects of medicine and health care research. Healthcare publishes Original Research Articles, Reviews, Case Reports, Research Notes and Short Communications. We encourage researchers to publish their experimental and theoretical results in as much detail as possible. For theoretical papers, full details of proofs must be provided so that the results can be checked; for experimental papers, full experimental details must be provided so that the results can be reproduced. Additionally, electronic files or software regarding the full details of the calculations, experimental procedure, etc., can be deposited along with the publication as “Supplementary Material”.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
