End-of-life care decisions using a Korean advance directive among cancer patient-caregiver dyads.
The Korean advance directive (K-AD) comprises a value statement, treatment directives, preferences for cardiopulmonary resuscitation (CPR), artificial ventilation, tube feeding, and hospice care, as well as a proxy appointment. The K-AD can facilitate a patient's decision making with respect to end-of-life (EoL) care. The present study aimed to examine the extent to which patient-caregiver dyads would use the K-AD and agree on EoL care decisions.



Using a descriptive study design, 81 cancer patients were invited to participate. The final sample consisted of 44 patient-caregiver dyads who completed survey questionnaires, including the K-AD. One patient did not complete all parts of the questionnaire, and 36 (44.4%) declined to participate. Content analysis was conducted to examine the K-AD value statements. Cohen's kappa coefficient was calculated to determine the degree of patient-caregiver dyadic agreement on K-AD treatment directives (Sudore & Fried, 2010).



Our patient participants had the following cancer diagnoses: colorectal 29.5%, breast 29.5%, and liver/biliary tract cancers, 15.9%. Half of the sample had advanced-stage disease. Spouses (70.5%) or adult children (20.4%) were the primary caregivers, with perceived bonding rated as fair (31.8%) or good (65.9%). Rejection of the K-AD was mainly due to the difficulty involved in deciding on EoL care (50%). Comfort while dying was the most common theme expressed by patients (73.8%) and caregivers (66.7%). In terms of treatment directives, dyads advocated for hospice care (66.7%) and reduced support for aggressive treatments of CPR or artificial ventilation. The use of CPR (κ = 0.43, p = 0.004) and artificial ventilation (κ = 0.28, p = 0.046) showed significantly mild to moderate concordance among the dyads. Some 16 of the 21 dyads identified their spouses as a proxy, with others designating their adult children.



The degree of patient-caregiver concordance on the K-AD seemed applicable, and achieved mild to moderate concordance. Our findings are exploratory but suggest the need for EoL discussions where patient-caregiver dyads are encouraged to participate in EoL care decision making.
Department of Nursing,Changwon National University,Changwon,Republic of Korea.
Shinmi
S
Kim
Department of Hematology and Oncology,University of Ulsan College of Medicine, Ulsan University Hospital,Ulsan,Republic of Korea.
Sujin
S
Koh
Medical Oncology and Hematology,Department of Internal Medicine,Pusan National University Yangsan Hospital,Yangsan,South Korea.
Kwonoh
K
Park
College of Nursing, Gachon University,Incheon,Republic of Korea.
Jinshil
J
Kim
D000328:Adult; D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D010361:Patients / Q000523:psychology; D036301:Qualitative Research; D056910:Republic of Korea; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
Cancer patients; Caregivers; End-of-life decision making; Korean advance directives