Purpose

The importance of dying with dignity in the intensive care unit (ICU) has been emphasized. The South Korean government implemented the “well-dying law” in 2018, which enables patients to refuse futile life-sustaining treatment (LST) after being determined as terminally ill. We aimed to study whether the well-dying law is associated with a significant change in the quality of death in the ICU.

Methods

The Quality of Dying and Death (QODD) questionnaires were prospectively collected from the doctors and nurses of deceased patients of four South Korean medical ICUs after the law was passed (January 2019 to May 2020). Results were compared with those of our previous study, which used the same metric before the law was passed (June 2016 to May 2017). We compared baseline characteristics of the deceased patients, enrolled staff, QODD scores, and staff opinions about withdrawing LST from before to after the law was passed.

Results

After the well-dying law was passed, deceased patients (N = 252) were slightly older (68.6 vs. 66.6, p = 0.03) and fewer patients were admitted to the ICU for post-resuscitation care (10.3% vs. 20%, p = 0.003). The mean total QODD score significantly increased after the law was passed (36.9 vs. 31.3, p = 0.001). The law had a positive independent association with the increased QODD score in a multiple regression analysis.

Conclusion

Our study is the first to show that implementing the well-dying law is associated with quality of death in the ICU, although the quality of death in South Korea remains relatively low and should be further improved.

中文翻译：

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与实施“临终法”相关的医护人员对重症监护病房死亡质量的看法发生了变化

目的

强调了在重症监护病房 (ICU) 有尊严地死去的重要性。韩国政府在 2018 年实施了“临终法”，允许患者在被确定为绝症后拒绝徒劳的生命维持治疗（LST）。我们旨在研究临终法则是否与 ICU 中死亡质量的显着变化有关。

方法

法律通过后（2019 年 1 月至 2020 年 5 月），前瞻性地从四个韩国医疗 ICU 的已故患者的医生和护士那里收集了死亡和死亡质量 (QODD) 问卷。结果与我们之前研究的结果进行了比较，该研究在法律通过之前（2016 年 6 月至 2017 年 5 月）使用了相同的指标。我们比较了法律通过前后死亡患者、登记工作人员、QODD 评分和工作人员对撤销 LST 的意见的基线特征。

结果

临终法通过后，死亡患者（N  = 252）年龄稍大（68.6 vs. 66.6，p  = 0.03），入住ICU接受复苏后护理的患者更少（10.3% vs. 20%，p  = 0.003)。法律通过后，平均总 QODD 得分显着增加（36.9 对 31.3，p  = 0.001）。在多元回归分析中，该定律与增加的 QODD 得分呈正相关。

结论

我们的研究首次表明实施临终法与 ICU 中的死亡质量相关，尽管韩国的死亡质量仍然相对较低，应进一步提高。