Korean J Fam Pract. 2017; 7(4): 520-526  https://doi.org/10.21215/kjfp.2017.7.4.520
The Influence of Roles and Extent of Information on Decision Making for Life Sustaining Treatment
Ahram Hong, Jung-Hyun Kim*, Hyeon-Guk Shin, Hyun-Woo Kwon, Jae-Hyun Youn, Young-Il Kim, Yun-Jae Han
Department of Family Medicine, Hana General Hopital, Cheongju, Korea
Jung-Hyun Kim
Tel: +82-43-230-6230, Fax: +82-43-230-6231
E-mail: astrobass@hanmail.net
Received: August 11, 2016; Revised: September 26, 2016; Accepted: October 4, 2016; Published online: August 20, 2017.
© Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The need for the consideration of decisions about terminal care has emerged with the development of medical technology. In this study, we used simulations to examine the differences in the decisions made with reference to different roles and extent of information, to provide basic material to establish guidelines on decision making in terminal situations.
Methods: Subjects were adult college students. We calibrated and compensated the decision making results of people with experience with long-time hospitalization to correct for the possible bias from preconceived notions. Decision making was assessed using responses to a self-produced, selfreported questionnaire. The roles and information differed between the groups. The general characteristics of the respondents were analyzed using the one-way ANOVA and chi-square tests. The Pearson’s chi square test was used to analyze the decisions, and a logistic regression was used to calculate the odd ratios of selected options.
Results: In total, 218 people participated in this study. In the two patients groups with standard and extended information, the selection rates of cardiopulmonary resuscitation were 60.0% and 90.6% (P<0.001), respectively, and those of respirator were 54.5% and 75.5% (P=0.023), respectively . The selection rates did not vary significantly among the surrogate groups. In the standard information groups of patients and surrogates, the selection rates of cardiopulmonary resuscitation were 60.0% and 96.3% (P<0.001), respectively, those of respirator were 54.5% and 90.7% (P<0.001), respectively, and those of hemodialysis were 60.0% and 81.5% (P=0.024), respectively. The selection rates did not vary significantly among the extended information groups.
Conclusion: In the simulation, subjects chose life sustaining treatment more actively when they were surrogates than when they were patients, and when they were provided extended information.
Keywords: Terminal Care; Decision Making; Representatives; Personal Autonomy
  1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382: 1525-33.
  2. Hahm KH, Lee I. Biomedical ethics policy in Korea: characteristics and historical development. J Korean Med Sci 2012; 27 Suppl: S76-81.
    Pubmed KoreaMed CrossRef
  3. Fritsch J, Petronio S, Helft PR, Torke AM. Making decisions for hospitalized older adults: ethical factors considered by family surrogates. J Clin Ethics 2013; 24: 125-34.
  4. Chima SC. Evaluating the quality of informed consent and contemporary clinical practices by medical doctors in South Africa: an empirical study. BMC Med Ethics 2013; 14 Suppl 1: S3.
    Pubmed KoreaMed CrossRef
  5. Kim CK. Seolmyeonguimuui beopjeokjiwi (Legal standing of liability of explanation). Gyeonghibuphak (Legal Studies Kyung Hee University) 2007;42(2): 204-5.
  6. Meeker MA, Jezewski MA. Family decision making at end of life. Palliat Support Care 2005; 3: 131-42.
    Pubmed CrossRef
  7. Bryant J, Skolarus LE, Smith B, Adelman EE, Meurer WJ. The accuracy of surrogate decision makers: informed consent in hypothetical acute stroke scenarios. BMC Emerg Med 2013; 13: 18.
    Pubmed KoreaMed CrossRef
  8. Bowers N, Eisenberg E, Montbriand J, Jaskolka J, Roche-Nagle G. Using a multimedia presentation to improve patient understanding and satisfaction with informed consent for minimally invasive vascular procedures. Surgeon 2017; 15: 7-11.
    Pubmed CrossRef
  9. Olver IN, Whitford HS, Denson LA, Peterson MJ, Olver SI. Improving informed consent to chemotherapy: a randomized controlled trial of written information versus an interactive multimedia CD-ROM. Patient Educ Couns 2009; 74: 197-204.
    Pubmed CrossRef
  10. Fraval A, Chandrananth J, Chong YM, Coventry LS, Tran P. Erratum to: Internet based patient education improves informed consent for elective orthopaedic surgery: a randomized controlled trial. BMC Musculoskelet Disord 2015; 16: 283.
    Pubmed KoreaMed CrossRef
  11. Volandes AE, Mitchell SL, Gillick MR, Chang Y, Paasche-Orlow MK. Using video images to improve the accuracy of surrogate decision-making: a randomized controlled trial. J Am Med Dir Assoc 2009; 10: 575-80.
    Pubmed KoreaMed CrossRef
  12. Rückholdt M, Tofler GH, Buckley T. The impact of hospitalisation on a visiting family member: a case study and discussion. Aust Crit Care 2017; 30:182-5.
    Pubmed CrossRef
  13. Lerwick JL. Psychosocial implications of pediatric surgical hospitalization. Semin Pediatr Surg 2013; 22: 129-33.
    Pubmed CrossRef
  14. Sharot T. The optimism bias. Time 2011; 177: 40-4, 46.
  15. Schenker Y, Crowley-Matoka M, Dohan D, Tiver GA, Arnold RM, White DB. I don’t want to be the one saying ‘we should just let him die’: intrapersonal tensions experienced by surrogate decision makers in the ICU. J Gen Intern Med 2012; 27: 1657-65.
    Pubmed KoreaMed CrossRef
  16. Patel D, Cohen ED, Barnato AE. The effect of framing on surrogate optimism bias: A simulation study. J Crit Care 2016; 32: 85-8.
    Pubmed KoreaMed CrossRef
  17. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions. Intensive Care Med 2016;42: 1118-27.
    Pubmed CrossRef

This Article