title: End-of-life communication in Korean older adults: With focus on advance care planning and advance directives.
abstract: The present article aimed to provide a comprehensive review of current status of end-of-life (EOL) care and sociocultural considerations in Korea, with focus on the EOL communication and use of advance directives (AD) in elderly Koreans. Through literature review, we discuss the current status of EOL care and sociocultural considerations in Korea, and provide a look-ahead. In Korea, patients often receive life-sustaining treatment until the very end of life. Advance care planning is rare, and most do-not-resuscitate decisions are made between the family and physician at the very end of patient's life. Koreans, influenced mainly by Confucian tradition, prefer a natural death and discontinuation of life-sustaining treatment. Although Koreans generally believe that death is natural and unavoidable, they tend not to think about or discuss death, and regard preparation for death as unnecessary. As a result, AD are completed by just 4.7% of the general adult population. This situation can be explained by several sociocultural characteristics including opting for natural death, wish not to burden others, preference for family involvement and trust in doctor, avoidance of talking about death, and filial piety. Patients often receive life-sustaining treatment until the very EOL, advance care planning and the use of AD is not common in Korea. This was related to unique sociocultural characteristics of Korea. A more active role of physicians, development of a more deliberate EOL discussion process, development of culturally appropriate AD and promotion of advance care planning might be required to provide good EOL care in Korea.
authors.affiliation: Department of Family Medicine, Seoul National University College of Medicine & Seoul National University Hospital, Seoul, Korea.|Center for Health Promotion and Optimal Aging, Seoul National University Hospital, Seoul, Korea.|Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.|JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Family Medicine, Seoul National University College of Medicine & Seoul National University Hospital, Seoul, Korea.|Center for Health Promotion and Optimal Aging, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Seoul National University College of Medicine & Seoul National University Hospital, Seoul, Korea.|Center for Health Promotion and Optimal Aging, Seoul National University Hospital, Seoul, Korea.|Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.|Institute on Aging, Seoul National University College of Medicine, Seoul, Korea.|Advanced Institutes of Convergence Technology, Seoul National University, Gyeonggi-do, Korea.
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
authors.affiliation: Department of Medical Education, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Yoo
authors.affiliation: Department of Neurology, Seoul National University College of Medicine & Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: SangYun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, Sungkyunkwan University College of Medicine & Samsung Medical Center, Seoul, Korea.
authors.forename: Jun-Hyun
authors.initials: JH
authors.lastname: Yoo
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration*; D016223:Advance Directives; D000368:Aged; D003142:Communication; D006801:Humans; D056910:Republic of Korea; D013727:Terminal Care / Q000458:organization & administration*
keywords: Korea; advance directives; death; elderly; end-of-life