연명의료결정법 대상 환자의 연명의료결정과 사망 전 의료이용에의 영향요인

Abstract

This study embarks on a detailed cohort analysis to identify the factors influencing life-sustaining treatment (LST) decisions and healthcare usage before death. Utilizing multinomial logistic regression, it examines a diverse sample of 1,072 patients, categorized into three groups: self-determination, family determination, and DNR. The majority of the cohort, 49.4%, falls under the self-determination group, with a significant proportion of patients (92.8%) suffering from cancer. We find that the most common medical intervention in the week preceding death was blood transfusions, accounting for 49.2% of cases. The study reveals that the self-determination group experienced lower daily healthcare costs, higher hospice utilization rates, and longer intervals between physician orders for life-sustaining treatment(POLST) or DNR completion and death, compared to the other groups. Moreover, patients with stupor on admission were significantly more likely to be in the family determination group (36.225 times) or the DNR group (19.422 times) than in the self-determination group. Furthermore, the likelihood of ICU use was higher in the family determination (3.627 times) and DNR groups (4.137 times), with the application of mechanical ventilation being 2.372 times more common in the family determination group and 4.209 times in the DNR group. Lastly, cardiopulmonary resuscitation was 9.122 times more prevalent in the DNR group compared to the self-determination group. The study concludes that self-determination in LST can significantly reduce unnecessary healthcare utilization before death and promote hospice care utilization, underscoring the necessity of supporting patients in planning their end-of-life care, including decisions about LST.