Impact of the Life-Sustaining Treatment Decisions Act on End-of-Life Care in the Emergency Department

Abstract

Background:

The Life-Sustaining Treatment (LST) Decisions Act in South Korea was implemented to promote patient-centered end-of-life (EoL) care.

Objectives:

To evaluate the impact of this legislation on LST practices for patients dying in the emergency department (ED).

Design:

A single-center retrospective study using interrupted time series (ITS) analysis.

Setting/Subjects:

Adult nontraumatic deaths in the South Korean ED between 2014 and 2024.

Measurements:

Changes in LST practices were assessed between pre- and post-Act groups (implemented February 4, 2018). Subgroup analyses by advanced cancer status were conducted, and interaction terms between ITS variables and advanced cancer status were evaluated using analysis of variance.

Results:

Among 1,058 patients (median age 77.0), rates of cardiopulmonary resuscitation (CPR) (26.8% vs. 15.1%, p < 0.001) and intubation (31.6% vs. 22.1%, p = 0.002) decreased after the Act, whereas antibiotic administration (60.6% vs. 69.3%, p = 0.009) and LST withdrawal (0.7% vs. 5.2%, p = 0.002) increased. The Act was associated with a decreasing postimplementation trend in intubation (p = 0.046). In patients with advanced cancer, CPR and intubation rates were similar before and after the Act, while a significant interaction between the Act and advanced cancer status was observed for CPR (p = 0.007).

Conclusions:

Following the legislation, the provision of invasive LST, such as CPR and intubation, at the EoL phase in the ED decreased. These shifts, primarily observed in patients without advanced cancer, indicate that the Act successfully catalyzed EoL discussions and promoted goal-concordant care for this population.