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Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study

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Abstract

Purpose

Although surrogate decision-making in cancer patients is well-known, few studies investigating the prevalence of surrogate decision-making over time have been reported. The objectives of this study were to investigate the level of surrogate decision-making in advanced cancer patients over time and the impact of demographic and clinical variables on surrogate decision-making.

Methods

The level of surrogate decision-making was measured in 572 consecutive cancer patients who died between January 1 and December 31, 2009. We reviewed 8,639 informed consent forms of these patients, calculated the proportion of decisions made by a surrogate (PDS) for each patient, and analyzed the association of PDS with demographic and clinical variables.

Results

Surrogates completed 40.3 % of all consent forms. The prevalence of surrogate decision-making was higher in the end-of-life period (death <7 days, OR = 29.05; reference, >365 days). Surrogates signed consent forms more frequently for do-not-resuscitate directives, intensive care unit admission, emergency hemodialysis, surgery and invasive interventions compared with chemotherapy, radiotherapy, and diagnostic tests (OR = 3.88, P < 0.001). Patients of older age (P = 0.036) and those with a shorter duration of management (P < 0.001) were independently associated with greater PDS.

Conclusions

Surrogate decision-making was frequently observed among Korean cancer patients in this study, especially when the patient’s death was imminent, and for decisions related to end-of-life care. Surrogates were also frequently involved in decisions for elderly or rapidly deteriorating patients. Healthcare professionals should consider the significant role of familial surrogates in the end-of-life period; comprehensive approaches are needed to preserve the best interest of the patients.

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Acknowledgements

This work was supported by a grant from the Innovative Research Institute for Cell Therapy, Republic of Korea (grant number: A062260)

Disclosure of potential conflicts of interest

The authors have nothing to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    June Koo Lee, Bhumsuk Keam, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim & Dae Seog Heo

  2. Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Bhumsuk Keam, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim & Dae Seog Heo

  3. Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Ah Reum An

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  1. June Koo Lee
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Correspondence to Dae Seog Heo.

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Lee, J.K., Keam, B., An, A.R. et al. Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study. Support Care Cancer 21, 183–190 (2013). https://doi.org/10.1007/s00520-012-1509-5

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  • DOI: https://doi.org/10.1007/s00520-012-1509-5

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