Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population

Young Ho Yun, Kyoung Nam Kim, Jin Ah Sim, Shin Hye Yoo, Miso Kim, Young Ae Kim, Beo Deul Kang, Hyun Jeong Shim, Eun Kee Song, Jung Hun Kang, Jung Hye Kwon, Jung Lim Lee, Eun Mi Nam, Chi Hoon Maeng, Eun Joo Kang, Young Rok Do, Yoon Seok Choi, Kyung Hae Jung

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS: All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION: Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.

Original languageEnglish
Pages (from-to)e020519
JournalBMJ open
Volume8
Issue number9
DOIs
Publication statusPublished - 2018 Sep 11

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Passive Euthanasia
Active Euthanasia
Assisted Suicide
Terminal Care
Family Physicians
Caregivers
Cross-Sectional Studies
Pain
Population
Neoplasms
Therapeutics
Physicians
Korea
Emotions
Logistic Models
Demography
Education

Keywords

  • active euthanasia
  • active pain control
  • attitudes toward death
  • modes of death
  • PAS
  • passive euthanasia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide) : a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. / Yun, Young Ho; Kim, Kyoung Nam; Sim, Jin Ah; Yoo, Shin Hye; Kim, Miso; Kim, Young Ae; Kang, Beo Deul; Shim, Hyun Jeong; Song, Eun Kee; Kang, Jung Hun; Kwon, Jung Hye; Lee, Jung Lim; Nam, Eun Mi; Maeng, Chi Hoon; Kang, Eun Joo; Do, Young Rok; Choi, Yoon Seok; Jung, Kyung Hae.

In: BMJ open, Vol. 8, No. 9, 11.09.2018, p. e020519.

Research output: Contribution to journalArticle

Yun, Young Ho ; Kim, Kyoung Nam ; Sim, Jin Ah ; Yoo, Shin Hye ; Kim, Miso ; Kim, Young Ae ; Kang, Beo Deul ; Shim, Hyun Jeong ; Song, Eun Kee ; Kang, Jung Hun ; Kwon, Jung Hye ; Lee, Jung Lim ; Nam, Eun Mi ; Maeng, Chi Hoon ; Kang, Eun Joo ; Do, Young Rok ; Choi, Yoon Seok ; Jung, Kyung Hae. / Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide) : a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. In: BMJ open. 2018 ; Vol. 8, No. 9. pp. e020519.
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abstract = "OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS: All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9{\%}) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95{\%} CI 1.33 to 2.36), caregiver role (aOR 1.67, 95{\%} CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95{\%} CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95{\%} CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95{\%} CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95{\%} CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95{\%} CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95{\%} CI 1.39 to 1.90) and PAS (aOR 1.61, 95{\%} CI 1.37 to 1.89). CONCLUSION: Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.",
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T1 - Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide)

T2 - a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population

AU - Yun, Young Ho

AU - Kim, Kyoung Nam

AU - Sim, Jin Ah

AU - Yoo, Shin Hye

AU - Kim, Miso

AU - Kim, Young Ae

AU - Kang, Beo Deul

AU - Shim, Hyun Jeong

AU - Song, Eun Kee

AU - Kang, Jung Hun

AU - Kwon, Jung Hye

AU - Lee, Jung Lim

AU - Nam, Eun Mi

AU - Maeng, Chi Hoon

AU - Kang, Eun Joo

AU - Do, Young Rok

AU - Choi, Yoon Seok

AU - Jung, Kyung Hae

PY - 2018/9/11

Y1 - 2018/9/11

N2 - OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS: All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION: Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.

AB - OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS: All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION: Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.

KW - active euthanasia

KW - active pain control

KW - attitudes toward death

KW - modes of death

KW - PAS

KW - passive euthanasia

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