End-of-life care in ICUs in East Asia

A comparison among China, Korea, and Japan

Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. Design: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. Setting: ICUs in China, Korea, and Japan. Subjects: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan). Interventions: None. Measurements and Main Results: Country was independently associated with differences in the practice of limiting multiple forms of life-sustaining treatments on multivariable generalized linear model analysis. Chinese respondents were least likely to apply do-not-resuscitate orders, even if they existed (p < 0.001). Japanese respondents were most likely to practice do not resuscitate for terminally ill patients during cardiac arrest, even when no such prior order existed (p < 0.001). Korean respondents' attitudes were in between those of Chinese and Japanese respondents as far as withdrawing total parenteral nutrition, antibiotics, dialysis, and suctioning was concerned. Chinese respondents were most uncomfortable discussing end-of-life care issues with patients, while Japanese respondents were least uncomfortable (p < 0.001). Chinese respondents were more likely to consider financial burden when deciding on limiting life-sustaining treatment (p < 0.001). Japanese respondents felt least exposed to personal legal risks when limiting life-sustaining treatment (p < 0.001), and the Korean respondents most wanted legislation to guide this issue (p < 0.001). The respondents' gender, religion, clinical experience, and primary specialty were also independently associated with the different perceptions of end-of-life care. Conclusions: Despite similarities in cultures and a common emphasis on the role of family, differences exist in physician perceptions and practices of end-of-life ICU care in China, Korea, and Japan. These findings may be due to differences in the degree of Westernization, national healthcare systems, economic status, and legal climate.

Original languageEnglish
Pages (from-to)1114-1124
Number of pages11
JournalCritical care medicine
Volume46
Issue number7
DOIs
Publication statusPublished - 2018 Jan 1

Fingerprint

Terminal Care
Far East
Korea
China
Japan
Physicians
Confucianism
Surveys and Questionnaires
Resuscitation Orders
Terminally Ill
Total Parenteral Nutrition
Religion
Jurisprudence
Heart Arrest
Climate
Legislation
Dialysis
Linear Models
Therapeutics
Economics

Keywords

  • Autonomy
  • East Asian countries
  • End-of-life care
  • Intensive care unit
  • Life-sustaining treatments

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group (2018). End-of-life care in ICUs in East Asia: A comparison among China, Korea, and Japan. Critical care medicine, 46(7), 1114-1124. https://doi.org/10.1097/CCM.0000000000003138

End-of-life care in ICUs in East Asia : A comparison among China, Korea, and Japan. / Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group.

In: Critical care medicine, Vol. 46, No. 7, 01.01.2018, p. 1114-1124.

Research output: Contribution to journalArticle

Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group 2018, 'End-of-life care in ICUs in East Asia: A comparison among China, Korea, and Japan', Critical care medicine, vol. 46, no. 7, pp. 1114-1124. https://doi.org/10.1097/CCM.0000000000003138
Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group. End-of-life care in ICUs in East Asia: A comparison among China, Korea, and Japan. Critical care medicine. 2018 Jan 1;46(7):1114-1124. https://doi.org/10.1097/CCM.0000000000003138
Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group. / End-of-life care in ICUs in East Asia : A comparison among China, Korea, and Japan. In: Critical care medicine. 2018 ; Vol. 46, No. 7. pp. 1114-1124.
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T1 - End-of-life care in ICUs in East Asia

T2 - A comparison among China, Korea, and Japan

AU - Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group

AU - Park, So Young

AU - Phua, Jason

AU - Nishimura, Masaji

AU - Deng, Yiyun

AU - Kang, Yan

AU - Tada, Keiichi

AU - Koh, Younsuck

AU - Du, Bin

AU - Qiu, Haibo

AU - Zhang, Xiangyu

AU - Dong, Yun

AU - Wan, Yong

AU - Gan, Cihai

AU - Zhang, Yawei

AU - Gao, Peiyang

AU - Chen, Hong

AU - Jia, Chao

AU - Xiao, Xianhua

AU - Xiang, Nutao

AU - Li, Jingsong

AU - Wang, Yushan

AU - Tang, Yaoqing

AU - Li, Jianguo

AU - An, Youzhong

AU - Ma, Xiaochun

AU - Wang, Xue

AU - Hu, Zhenjie

AU - Qin, Tiehe

AU - Tada, Keiichi

AU - Nakamura, Toshiaki

AU - Sanui, Masamitsu

AU - Fujino, Yuji

AU - Shiragami, Gotaroh

AU - Kotani, Joji

AU - Miyasho, Kohji

AU - Morisaki, Hiroshi

AU - Eguchi, Yutaka

AU - Takeda, Shinhiro

AU - Nishimura, Shinya

AU - Nishida, Osamu

AU - Tanigawa, Koichi

AU - Takada, Koji

AU - Oda, Sigeto

AU - Fukuoka, Toshio

AU - Sawamoto, Toru

AU - Hashimoto, Satoru

AU - Sobue, Kazuya

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AU - Morita, Kiyoshi

AU - Taniguchi, Hiroyuki

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N2 - Objectives: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. Design: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. Setting: ICUs in China, Korea, and Japan. Subjects: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan). Interventions: None. Measurements and Main Results: Country was independently associated with differences in the practice of limiting multiple forms of life-sustaining treatments on multivariable generalized linear model analysis. Chinese respondents were least likely to apply do-not-resuscitate orders, even if they existed (p < 0.001). Japanese respondents were most likely to practice do not resuscitate for terminally ill patients during cardiac arrest, even when no such prior order existed (p < 0.001). Korean respondents' attitudes were in between those of Chinese and Japanese respondents as far as withdrawing total parenteral nutrition, antibiotics, dialysis, and suctioning was concerned. Chinese respondents were most uncomfortable discussing end-of-life care issues with patients, while Japanese respondents were least uncomfortable (p < 0.001). Chinese respondents were more likely to consider financial burden when deciding on limiting life-sustaining treatment (p < 0.001). Japanese respondents felt least exposed to personal legal risks when limiting life-sustaining treatment (p < 0.001), and the Korean respondents most wanted legislation to guide this issue (p < 0.001). The respondents' gender, religion, clinical experience, and primary specialty were also independently associated with the different perceptions of end-of-life care. Conclusions: Despite similarities in cultures and a common emphasis on the role of family, differences exist in physician perceptions and practices of end-of-life ICU care in China, Korea, and Japan. These findings may be due to differences in the degree of Westernization, national healthcare systems, economic status, and legal climate.

AB - Objectives: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. Design: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. Setting: ICUs in China, Korea, and Japan. Subjects: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan). Interventions: None. Measurements and Main Results: Country was independently associated with differences in the practice of limiting multiple forms of life-sustaining treatments on multivariable generalized linear model analysis. Chinese respondents were least likely to apply do-not-resuscitate orders, even if they existed (p < 0.001). Japanese respondents were most likely to practice do not resuscitate for terminally ill patients during cardiac arrest, even when no such prior order existed (p < 0.001). Korean respondents' attitudes were in between those of Chinese and Japanese respondents as far as withdrawing total parenteral nutrition, antibiotics, dialysis, and suctioning was concerned. Chinese respondents were most uncomfortable discussing end-of-life care issues with patients, while Japanese respondents were least uncomfortable (p < 0.001). Chinese respondents were more likely to consider financial burden when deciding on limiting life-sustaining treatment (p < 0.001). Japanese respondents felt least exposed to personal legal risks when limiting life-sustaining treatment (p < 0.001), and the Korean respondents most wanted legislation to guide this issue (p < 0.001). The respondents' gender, religion, clinical experience, and primary specialty were also independently associated with the different perceptions of end-of-life care. Conclusions: Despite similarities in cultures and a common emphasis on the role of family, differences exist in physician perceptions and practices of end-of-life ICU care in China, Korea, and Japan. These findings may be due to differences in the degree of Westernization, national healthcare systems, economic status, and legal climate.

KW - Autonomy

KW - East Asian countries

KW - End-of-life care

KW - Intensive care unit

KW - Life-sustaining treatments

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