Factors influencing self-decision in withholding or withdrawal of life-sustaining treatments among older patients admitted to general hospital: A retrospective case-control study

• 발행기관: 한국노인간호학회
• 저자명: Young Min Jeong Hee-Ju Kim
• 간행물 정보: 『노인간호학회지』제27권 제3호, 271~284쪽, 전체 14쪽
• 주제분류: 의약학 > 의학일반
• 파일형태: PDF
• 발행일자: 2025.08.31

국문 초록

Purpose This study aimed to identify factors influencing older patients’ self-decision in withholding or withdrawing life-sustaining treatment (LST) during hospitalization. Methods For this retrospective case-control study (self-decision versus family-decision groups), we used electronic medical records. The sample included 624 older patients who died after completing the LST implementation form. 249 (39.9%) patients were in the self-decision group versus 375 (60.1%) patients in the family-decision group. We performed chi-square tests, t-tests, and binary logistic regression. Results Receiving treatment in an internal medicine department (odds ratio [OR]=12.60, 95% confidence interval [CI]=2.83~56.13), admission to a general ward (OR=2.83, 95% CI=1.33~6.02), experiencing pain (OR=2.64, 95% CI=1.68~4.13), being alert upon admission (OR=2.27, 95% CI=1.15~4.51), having a diagnosis of cancer (OR=2.01, 95% CI=1.16~3.49), and younger age (65~74 years) were significantly associated with an increased likelihood of self-decision. All factors increased the likelihood of self-decision. The self-decision group showed higher rates of withholding or withdrawing LST interventions (e.g., ventilators, dialysis, chemotherapy, extracorporeal membrane oxygenation, transfusions, and vasopressors) and received more hospice and palliative care with reduced Intensive Care Unit deaths. Conclusion The self-decision group (i.e., those in internal medicine, with cancer, admitted to general wards, and maintaining consciousness) chose reduced futile LSTs. These findings highlight the need to develop a standardized protocol for counseling and education to facilitate informed end-of-life decisions among older inpatients.

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키워드

Aged Life-sustaining treatment Patient self-decision Terminal care