title: Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies.
abstract: BACKGROUND
  The role of the physician in end-of-life decision-making is complicated. To analyze the controversies that surround therapeutic decision-making and the withholding of life-sustaining treatments, the authors compared values regarding therapeutic intervention that were held by physicians and family members of patients with terminal malignancies.
  
  
  METHODS
  One hundred fourteen patients with either advanced-stage or terminal disease were enrolled in the current study. Questionnaires were administered to the duty physician and to patients' family members. The questions covered issues such as the use of new anticancer agents with only partial efficacy (15%) and the use of opioid analgesics, intravenous nutrition, feeding tubes, antibiotics, and hemodialysis. In addition, participants were asked about the administration of cardiopulmonary resuscitation (CPR) and the use of ventilators, and when the patient's family consented, the same questionnaire was administered to the patient as well.
  
  
  RESULTS
  Seventeen of 114 families refused to answer the questionnaire. Of the 97 available families, only 14 permitted access to the patient. Of those 14 patients, 5 refused to complete the questionnaire. Overall, 100% of families and 87% of patients had some knowledge regarding malignant disease, but only 69% of families and 37% of patients clearly understood the stage of the patient's disease. The use of a new agent with only partial efficacy (approximately 15%) was accepted by 41% of physicians and by 60% of families. The concordance rate between patients' physicians and family members regarding the same patient was 42%. The rankings of the acceptance of treatment by physicians were as follows: opioid analgesics, 100%; antibiotics, 91%; feeding tube, 87%; and intravenous nutrition, 78%. The rankings of the same items by family members were as follows: opioid analgesics, 92%; antibiotics, 89%; intravenous nutrition, 86%; and feeding tube, 75%. The concordance rates between patients' physicians and families were lowest for ventilator application (39%) and CPR (47%).
  
  
  CONCLUSIONS
  Values held on issues such as therapeutic decision-making and the withholding of life-sustaining treatment for patients with terminal malignancies were discordant between physicians and family members. To resolve controversies regarding the role of the physician in end-of-life decision-making, the values of physicians, patients, and family members should be considered in the final decision-making process.
authors.affiliation: Seoul Municipal Boramae Hospital and Department of Internal MEdicine, Seoul National University College of Medicine, Chongno-gu, Seoul, Republic of Korea.
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Oh
authors.forename: Jee-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Chee-Hun
authors.initials: CH
authors.lastname: Lee
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Lim
authors.forename: Kyung-Hye
authors.initials: KH
authors.lastname: Jung
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
authors.forename: Yung-Jue
authors.initials: YJ
authors.lastname: Bang
authors.forename: Noe Kyeong
authors.initials: NK
authors.lastname: Kim
mesh_terms: D016223:Advance Directives; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007723:Korea; D008020:Life Support Care / Q000639:trends*; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards* / Q000639:trends; D028761:Withholding Treatment