부산대학교 도서관

Introduction In Korea, the Physician Orders for Life-Sustaining Treatment (POLST) has been implemented since 2018, for the refusal of meaningless life-prolonging treatment and a death with dignity. The purpose of this study is to investigate how the POLST is actually applied to patients with cancer who have been admitted to the intensive care unit (ICU). Method The medical records of patients who received POLST among cancer patients admitted to the medical ICU from February 2018 to June 2020 were retrospectively reviewed. Result A total of 1049 cancer patients were admitted to the medical ICU, 604 of those patients who received POLST were included during this study period. Among them, 29 patients (4.8%) received POLST before admission to the ICU, and 575 patients (95.2%) obtained POLST after admission to the ICU. The average time from the assessment for the patient at the End Stage of Life to the verification of Decision of patient or patient family was about 0.54 days and the assessment and verification was done on the same day in 583 patients (96.5%). The decision on Life-Sustaining Treatment (LST) plan were done by the patient’s family in 466 patients (77.2%). Only 138 patients (22.8%) self-determined the LST plan. In the 142 patients (23.5%), POLST was received within 48 hours after the admission to the ICU. Three-hundred forty-four patients (60.0%) were transfer to the ward after clinical improvement and 87 surviving patients (14.4%) were discharged. Conclusion Even after the implementation of POLST, the Decision on the LST plan were done by the patients’ family in most cases. About half of the patients who received POLST were transferred to the ward after advanced intensive care. There still seems to be a gap between the LST decision system and the medical environment.