Early Integrated Palliative Care in Patients With Advanced Cancer: A Randomized Clinical Trial.

Importance: Limited data suggest that early palliative care (EPC) improves quality of life (QOL) and survival in patients with advanced cancer. Objective: To evaluate whether comprehensive EPC improves QOL; relieves mental, social, and existential burdens; increases survival rates; and helps patients develop coping skills. Design, Setting, and Participants: This nonblinded randomized clinical trial (RCT) recruited patients from 12 hospitals in South Korea from September 2017 to October 2018. Patients aged 20 years or older with advanced cancer who were not terminally ill but for whom standard chemotherapy has not been effective were eligible. Participants were randomized 1:1 to the control (receiving usual supportive oncological care) or intervention (receiving EPC with usual oncological care) group. Intention-to-treat data analysis was conducted between September and December 2022. Interventions: The intervention group received EPC through a structured program of self-study education materials, telephone coaching, and regular assessments by an integrated palliative care team. Main Outcomes and Measures: The primary outcome was the change in overall QOL score (assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) from baseline to 24 weeks after enrollment, with evaluations also conducted at 12 and 18 weeks. Secondary outcomes were social and existential burdens (assessed with the McGill Quality of Life Questionnaire) as well as crisis-overcoming capacity and 2-year survival. Results: A total of 144 patients (83 males [57.6%]; mean [SD] age, 60.7 (7.2) years) were enrolled, of whom 73 were randomized to the intervention group and 71 to the control group. The intervention group demonstrated significantly greater changes in scores in overall health status or QOL from baseline, especially at 18 weeks (11.00 [95% CI, 0.78-21.22] points; P = .04; effect size = 0.42). However, at 12 and 24 weeks, there were no significant differences observed. Compared with the control group, the intervention group also showed significant improvement in self-management or coping skills over 24 weeks (20.51 [95% CI, 12.41-28.61] points; P < .001; effect size = 0.93). While the overall survival rate was higher in the intervention vs control group, the difference was not significant. In the intervention group, however, those who received 10 or more EPC interventions (eg, telephone coaching sessions and care team meetings) showed a significantly increased probability of 2-year survival (53.6%; P < .001). Conclusions and Relevance: This RCT demonstrated that EPC enhanced QOL at 18 weeks; however, no significant improvements were observed at 12 and 24 weeks. An increased number of interventions sessions was associated with increased 2-year survival rates in the intervention group. Trial Registration: ClinicalTrials.gov Identifier: NCT03181854.

Different effects between the current capability of and changes in self-management strategies on improving health behavior and psychological health after 6 months: evidence from a prospective cohort study of patients with cancer.

PURPOSE: We aimed to examine different effects of the current capability of and changes in self-management strategies on improving health behavior and psychological health (satisfaction of life, depression, and anxiety) after 6 months in cancer patients. METHODS: A prospective cohort study was conducted, including 540 cancer patients. We measured cancer patients' self-management strategies' capability with Smart Management Strategies for Health (SMASH) Assessment Tool (SAT) baseline scores and changes with SMASH change scores based on a clinically meaningful 10% change of the scores. We conducted adjusted multivariate multiple logistic regression analyses using the stepwise selection method between SMASH baseline and health behavior, satisfaction with life (SWL), depression, and anxiety and between SMASH changes and health behavior, SWL, depression, and anxiety. RESULTS: 256 cancer patients completed both the first and second surveys. While various SMASH capabilities positively affected each health behavior, SWL, depression, and anxiety, the positive-reframing strategy at baseline only affected all health behavior, SWL, and depression. However, based on SMASH changes, using the positive-reframing strategy a lot for 6 months adversely affected some physical health behaviors' practice (balanced diet and stop smoking and drinking). Changes in the life value pursuing strategy only positively affected HB (proactive living) and anxiety. CONCLUSION: SMASH baseline and change scores were generally associated with practicing cancer patients' health behaviors, lower depression, and anxiety. However, it is necessary to consider that excessively using the positive-reframing strategy would interfere with practicing a balanced diet and stopping smoking and drinking behaviors.

Self-Management Strategy Clustering, Quality of Life, and Health Status in Cancer Patients Considering Cancer Stages.

BACKGROUND: In the cancer-care continuum, self-management can help cancer patients regardless of their treatment plan or cancer stage. However, research examining self-management strategy clusters considering cancer stages is lacking. Thus, we examined self-management strategy clusters considering cancer stages and the effects of self-management strategy clusters on quality of life (QoL) and overall health status. METHOD: A total of 256 patients who completed both baseline and second surveys for a 6-month period ultimately participated in this prospective cohort study. To identify the interrelationship between self-management strategies measured by the Smart management strategies for health assessment tool (SAT), we conducted cluster analysis using a principal component analysis in varimax rotation and the k-mean clustering method. We also performed multivariate-adjusted analyses in QoL and overall health status comparisons by dividing the cancer stage into early (I, II) and advanced (III, IV). RESULTS: All patients experienced two domains of self-management strategies concurrently. However, self-management strategy clusters differed by cancer stage, and the effect of self-management strategy clusters on quality of life and overall health status also differed. Self-management strategy clusters effectively improved the quality of life and overall health status of the entire cohort of patients, even in patients with advanced-stage cancer. CONCLUSION: This study revealed that the pattern of using self-management strategies might differ by cancer stage. The strategy cluster positively affected QoL and overall health status in cancer patients. Identifying the self-management clusters of cancer patients with different cancer stages may have clinical implications for supporting their health management.

Importance of worthwhile life and social health as predictors of suicide ideation among cancer patients.

OBJECTIVE: We identify the most associative factors among existential well-being, health-related quality of life, and health behaviors' sub-factors for cancer patients' suicidal ideation (SI) to develop practical intervention tools for general cancer patients in South Korea. PARTICIPANTS: We surveyed 766 cancer patients from two hospitals in South Korea. The eligibility criteria were as follows: 18 years of age or older, diagnosed with cancer, aware of the stage, and capable of understanding the purpose of the study. METHODS: We performed a multidimensional multivariate analysis to find the factors that are most associated with SI for cancer patients. RESULTS: The results showed that life worthwhile (adjusted odds ratio (aOR), 3.946; 95% CI, 1.64-9.48), social functioning (aOR, 2.817; 95% CI, 1.19-6.65), and living with loved ones (aOR, 0.353; 95% CI, 0.15-0.84) were the most predictive factors for SI. CONCLUSION: To prevent SI in cancer patients, it might be necessary to help them feel that their lives are worthwhile while helping them maintain a high degree of social health. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY: It is important to help cancer patients value their life and lead the high-quality social life to reduce their SI.

Korean Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer.

CONTEXT: The goal of palliative care is to maximize the quality of life and thus maintain the dignity of patients facing problems associated with a life-threatening illness. The Patient Dignity Inventory (PDI) is an instrument used to measure various sources of distress that can impact patients' sense of dignity at the end of life. OBJECTIVES: We aimed to obtain a Korean translation of the PDI (PDI-K) and evaluate its psychometric properties in patients with advanced cancer. METHODS: Translation and cultural adaptation of the PDI were performed to obtain the Korean version. In a sample of 131 inpatients and outpatients with advanced cancer, psychometric properties, including factor structure, internal consistency, and concurrent validity, were examined. Concurrent validity was evaluated using the Edmonton Symptom Assessment System, the Hospital Anxiety and Depression Scale, and the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS: Cronbach's α for the PDI-K was 0.96. Four factors were identified by exploratory factor analysis, accounting for 68.7% of the overall variance: Dependency and Physical Symptoms, Psychological Distress, Existential Distress, and SocialSupport. Concurrent validity was confirmed by significant correlations between PDI-K and Edmonton Symptom Assessment System (r = 0.40 to 0.59, P < 0.001), Hospital Anxiety and Depression Scale (r = 0.78 to 0.81, P < 0.001), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (r = -0.32 to -0.57, P < 0.001). CONCLUSION: Our findings indicate that the PDI-K is a valid and reliable instrument to measure dignity-related distress in patients with advanced cancer. This tool provides a four-factor Korean language alternative to the PDI.

Impact of family caregivers' awareness of the prognosis on their quality of life/depression and those of patients with advanced cancer: a prospective cohort study.

PURPOSE: A caregiver's prognostic awareness can affect clinical decisions for the patient. The purpose of this study was to examine the impact of family caregivers' prognostic awareness on the quality of life (QOL) and emotional state of both patients with advanced cancer and their caregivers. METHODS: This prospective cohort study was conducted from December of 2016 to January of 2018. A total of 159 patients with advanced cancer and an equal number of caregivers participated. The investigation tools used include the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15-Palliative, the McGill Quality of Life Questionnaire, and the Patient Health Questionnaire-9, and evaluation was performed at baseline, 3 months, and 6 months. Covariance analysis with a general linear modeling was used to compare changes in quality of life scores according to the caregivers' awareness of the prognosis. RESULTS: Mean patient overall QOL score increased in the group of caregivers who were aware of prognosis and decreased in the caregivers who were not aware of the prognosis (p = 0.018). The changes over time in the patients' QOL scores associated with symptoms improved with caregiver awareness (pain, p = 0.017; dyspnea, p = 0.048; appetite loss, p = 0.045). The percentage of depressed patients was smaller after 3 months in the group with caregivers aware of the prognosis (baseline to 3 months p = 0.028). Caregivers who did not understand their patients' prognosis exhibited better existential well-being (p = 0.036), and the incidence of depression was lower in this group at 3 months (p = 0.024). CONCLUSION: Caregivers' prognostic awareness may improve the quality of life and mood in patients with advanced cancer; however, this awareness may harm the quality of life and mood of the caregivers. These results may aid in developing in-depth interventions regarding prognosis for both patients and their caregivers.

The Attitudes of Physicians and the General Public toward Prognostic Disclosure of Different Serious Illnesses: a Korean Nationwide Study.

BACKGROUND: Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. METHODS: We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. RESULTS: For most illnesses, most physicians (adjusted proportions - end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was "the patient's right to know his/her condition" (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was "psychological burden such as anxiety and depression" (35.8%), while for the physicians it was "disclosure would have no beneficial effect" (42.4%). CONCLUSION: Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

The major effects of health-related quality of life on 5-year survival prediction among lung cancer survivors: applications of machine learning.

The primary goal of this study was to evaluate the major roles of health-related quality of life (HRQOL) in a 5-year lung cancer survival prediction model using machine learning techniques (MLTs). The predictive performances of the models were compared with data from 809 survivors who underwent lung cancer surgery. Each of the modeling technique was applied to two feature sets: feature set 1 included clinical and sociodemographic variables, and feature set 2 added HRQOL factors to the variables from feature set 1. One of each developed prediction model was trained with the decision tree (DT), logistic regression (LR), bagging, random forest (RF), and adaptive boosting (AdaBoost) methods, and then, the best algorithm for modeling was determined. The models' performances were compared using fivefold cross-validation. For feature set 1, there were no significant differences in model accuracies (ranging from 0.647 to 0.713). Among the models in feature set 2, the AdaBoost and RF models outperformed the other prognostic models [area under the curve (AUC) = 0.850, 0.898, 0.981, 0.966, and 0.949 for the DT, LR, bagging, RF and AdaBoost models, respectively] in the test set. Overall, 5-year disease-free lung cancer survival prediction models with MLTs that included HRQOL as well as clinical variables improved predictive performance.

Efficacy of health coaching and a web-based program on physical activity, weight, and distress management among cancer survivors: A multi-centered randomised controlled trial.

OBJECTIVES: To investigate the efficacy of health coaching and a web-based program on survivor physical activity (PA), weight, and distress management among stomach, colon, lung and breast cancer patients. METHODS: This randomised, controlled, 1-year trial conducted in five hospitals recruited cancer survivors within 2 months of completing primary cancer treatment who had not met ≥1 of these behavioural goals: (i) conducting moderate PA for at least 150 minutes/week or strenuous exercise for over 75 minutes per week or, in the case of lung cancer patients, low or moderate intensity exercise for over 12.5 MET per week, (ii) maintaining normal weight, and (iii) attaining a score >72 in the Post Traumatic Growth Inventory (PTGI). Participants were randomly assigned to one of three groups: the control group, a web-only group, or a health coaching + web group. The primary endpoint was based on a composite of PA, weight, and PTGI score at 12 months. RESULTS: Patients in the health coaching + web group (difference = 6.6%, P = .010) and the web-only group (difference = 5.9%, P = .031) had greater overall improvements across the three-outcome composite than the control group. The health coaching + web group had greater overall improvement in PTGI (difference = 12.6%; P < .001) than the control group, but not in PA and weight. CONCLUSION: The web-based program, with or without health coaching, may improve health behaviours including PA, weight, and distress management among cancer survivors within 2 months of completing primary cancer treatment. The web-based program with health coaching was mainly effective for reducing psychological distress.

The Impacts of Prognostic Awareness on Mood and Quality of Life Among Patients With Advanced Cancer.

BACKGROUND: Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient's satisfaction and increase depression. AIM: The purpose of this study is to assess whether patients' prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancer. DESIGN AND PARTICIPANTS: In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients' prognostic awareness at baseline, 3 months, and 6 months. RESULTS: This study found significant differences in changes of QoL based on patients' prognostic awareness. From baseline to 3 months, emotional functioning (P = .039), pain (P = .042), existential well-being (P = .025), and social support (P = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning (P = .037), emotional functioning (P = .002), nausea/vomiting (P = .048), and constipation (P = .039) subscale scores and existential well-being scores (P = .025). No significant difference between the groups was found in terms of depression. CONCLUSION: Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.

Association of illness understanding with advance care planning and end-of-life care preferences for advanced cancer patients and their family members.

PURPOSE: Little has been determined regarding the association between patients' and families' illness understanding and preferences for medical care. We aimed to evaluate the association of illness understanding with advance care planning (ACP) and preferences for end-of-life care, such as aggressive care, early palliative care (EPC), and hospice care, among advanced cancer patients and their family caregivers. METHODS: Patients were recruited for a prospective cohort study at outpatient and inpatient facilities in nine university hospitals in Korea (n = 150), and their primary family caregivers were also asked to participate (n = 101). Data on ACP and end-of-life care preferences were collected only at baseline in the cohort study with optional questions and were used to analyze these study results. RESULTS: Patients with illness understanding were more likely to have documented physician orders for life-sustaining treatment (POLSTs) (adjusted odds ratio [aOR] of 4.94) and to have discussed ACP with their families (aOR 2.15) than those who did not. Being expected to live for several months, they were unlikely to prefer active treatment. Caregivers understanding patients' illness were more likely to write advance directives (ADs) and to discuss ACP; furthermore, they had already discussed ACP with family members. They did not prefer active treatment or life-sustaining treatments when their family members were expected to die within a few weeks. There was no significant association between illness understanding and preferences for EPC. CONCLUSION: Accurately recognizing an incurable disease is associated with preferences for more ACP and less aggressive care but not with preferences for EPC or hospice care among both advanced cancer patients and their family caregivers.

Predicting Disease-Free Lung Cancer Survival Using Patient Reported Outcome (PRO) Measurements with Comparisons of Five Machine Learning Techniques (MLT).

The study was to develop the lung cancer patients' prediction model for predicting 5-year survival after completion of treatment by using Machine Learning Technology (MLT), adding patient reporting (PRO) measurements of lung cancer survivors to a variety of clinical parameters. Finally, the survival prediction models with the addition of lung cancer survivors' PRO measurements to the well-known clinical variables, based on diverse MLT, improved the predictive performance that explains 5-year disease-free lung cancer survival.

Efficacy of a Decision Aid Consisting of a Video and Booklet on Advance Care Planning for Advanced Cancer Patients: Randomized Controlled Trial.

CONTEXT: Few randomized controlled trials of advance care planning (ACP) with a decision aid (DA) show an effect on patient preferences for end-of-life (EOL) care over time, especially in racial/ethnic settings outside the U.S. OBJECTIVES: The objective of this study was to examine the effect of a decision aid consisting of a video and an ACP booklet for EOL care preferences among patients with advanced cancer. METHODS: Using a computer-generated sequence, we randomly assigned (1:1) patients with advanced cancer to a group that received a video and workbook that both discussed either ACP (intervention group) or cancer pain control (control group). At baseline, immediately after intervention, and at 7 weeks, we evaluated the subjects' preferences. The primary outcome was preference for EOL care (active treatment, life-prolonging treatment, or hospice care) on the assumption of a fatal disease diagnosis and the expectation of death 1) within 1 year, 2) within several months, and 3) within a few weeks. We used Bonferroni correction methods for multiple comparisons with an adjusted P level of 0.005. RESULTS: From August 2017 to February 2018, we screened 287 eligible patients, of whom 204 were enrolled to the intervention (104 patients) or the control (100 patients). At postintervention, the intervention group showed a significant increase in preference for active treatment, life-prolonging treatment, and hospice care on the assumption of a fatal disease diagnosis and the expectation of death within 1 year (P < 0.005). Assuming a life expectancy of several months, the change in preferences was significant for active treatment and hospice care (P < 0.005) but not for life-prolonging treatment. The intervention group showed a significant increase in preference for active treatment, life-prolonging treatment, and hospice care on the assumption of a fatal disease diagnosis and the expectation of death within a few weeks (P < 0.005). From baseline to 7 weeks, the decrease in preference in the intervention group was not significant for active treatment, life-prolonging treatment, and hospice care in the intervention group in the subset expecting to die within 1 year, compared with the control group. Assuming a life expectancy of several months and a few weeks, the change in preferences was not significant for active treatment and for life-prolonging treatment but was significantly greater for hospice care in the intervention group (P < 0.005). CONCLUSION: ACP interventions that included a video and an accompanying book improved preferences for EOL care.

Comparison of quality of life and health behaviors in survivors of acute leukemia and the general population.

We aimed to compare the health-related quality of life and health behaviors of acute leukemia (AL) survivors with that of the general population from two cohorts. AL survivors (n = 149) completed a set of questionnaires to evaluate quality of life, mental status, and health behaviors. AL survivors had more physical and mental difficulties (problems with usual activities, 15% vs. 5%, p < 0.001; anxiety or depression, 24% vs. 9%, p < 0.001; pain, 35% vs. 20%, p = 0.002) and more financial difficulties (p < 0.001) than the general population. Survivors who received stem cell transplantation (SCT) had significantly worse problems with role functioning, fatigue, pain, dyspnea, and insomnia, and had higher depression scores than chemotherapy group (p = 0.024). In terms of health behaviors, AL survivors had lower rates of smoking and drinking and higher influenza vaccination rates than the general population. However, only 17% of survivors had been recommended to receive screening for other cancers from health-care providers, and 67% thought their risk for other cancers was equal or lower than that of the general population. Cancer screening rates were even lower in the SCT group than in the chemotherapy group (p = 0.041). Our study indicates that clinicians should establish more appropriate survivorship care plans.

Correction to: Priorities of a "good death" according to cancer patients, their family caregivers, physicians, and the general population: a nationwide survey.

While recently extending that research, however, we discovered that 236 members of the general population were mistakenly duplicated by the investigating agency (Word Research) and 1241 were reported rather than 1005. Here, we present corrections and discuss the relevant data.

Public support for health taxes and media regulation of harmful products in South Korea.

BACKGROUND: Public health policy is inevitably associated with either a strong presence or lack of public support. We investigated factors associated with both the public support of and opposition to health taxes and the media regulation regarding advertising harmful products in Korea. METHODS: We interviewed 1200 respondents that were recruited using an equal-probability sampling method in accordance with the 2016 Korean census. Our investigation examined the extent of support and opposition towards health taxes and the media regulation of advertising that targets the consumption of tobacco, alcohol, and unhealthy foods according to socioeconomic characteristics, health habits, body mass index (BMI), and exposure to the advertising of harmful products. The study was conducted using a univariate and stepwise multivariate regression analysis. RESULTS: The majority (71.8%) of the respondents were supportive of imposing health taxes in general. Despite a high prevalence of tobacco and alcohol consumption among the respondents, they strongly supported media regulation of tobacco (72.3%), alcohol (63.7%), and eating broadcasts (51.9%) food advertising (44.0%). Those that were non-smokers, earned a high-income, were married, or had a child were likely to support at least one kind of regulation regarding alcohol and smoking related advertising. An exposure to excessive advertising of unhealthy products was associated with increase of respondents supporting the media regulation. Those who regarded the media as being influential seemed to be more supportive of health taxes or media regulation. CONCLUSION: Our results indicated strong public support among the respondents for health taxes and the media regulation regarding the advertising of unhealthy products. Based on our data, we are optimistic that countries whose population show a high rate of tobacco, alcohol or unhealthy food consumption may launch public policy in addressing these factors.

Aspirin Does Not Prevent Pancreatic Cancer in a Large Asian Cohort.

BACKGROUND: Evidence has suggested that aspirin reduces the incidence of several cancers, but these benefits may not occur with pancreatic cancer. METHODS: A 12-year nationwide longitudinal cohort merged with the health checkup data was divided into "exposure ascertainment period" and "outcome ascertainment period" to avoid immortal time bias. The daily defined dose system was used to indicate the drug exposure. RESULTS: We found no significant association between aspirin use and incident pancreatic cancer based on HR. CONCLUSIONS: Aspirin does not prevent pancreatic cancer. IMPACT: A large Asian cohort study with reliable medication information affirms no impact of aspirin on pancreatic cancer development.

Attitudes of the General Public, Cancer Patients, Family Caregivers, and Physicians Toward Advance Care Planning: A Nationwide Survey Before the Enforcement of the Life-Sustaining Treatment Decision-Making Act.

CONTEXT: To respect a patient's wish for end-of-life care, "the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life" was enacted in South Korea in 2016. Current understanding of people who would be involved in advance care planning (ACP) is crucial to disseminate it systematically. OBJECTIVES: The objective of this study was to investigate awareness and attitudes toward ACP in South Korea. METHODS: A multicenter, nationwide cross-sectional study was conducted, a survey regarding ACP among four groups that would have different positions and experiences: 1001 cancer patients, 1006 family caregivers, 928 physicians, and 1241 members of the general public. RESULTS: A total of 15% of the general population, 33% of the patients and caregivers, and 61% of the physicians had knowledge of advance directives. More than 64% of the general population, above 72% of the patients and caregivers, and 97% of the physicians were willing to do so when the disease status was aggravated or terminal. The possibility for changing the plan, uncertainty as to whether directives would actually be followed, and psychological discomfort were common reasons for not wanting to engage in ACP. Routine recommendations for a specific medical condition, heightened accessibility, and health insurance support were common factors that could help facilitate ACP. CONCLUSION: Our findings suggest that strategies for promoting ACP should reflect different perspectives among the general public, patients, family caregivers, and physicians. Public advocacy, resources for approaching and integrating ACP into routine health care, as well as systematic support provisions are needed.

Regional Differences in Colorectal Cancer Mortality Between 2000 and 2013 in Republic of Korea.

OBJECTIVE: Colorectal cancer (CRC) is the fourth most common site for cancer death in the Republic of Korea. The aim of this study was to describe the trends of colorectal cancer mortality by region. METHODS: CRC mortality trends in Republic of Korea were described by region using a Joinpoint regression model in both sexes. The annual percent changes (APCs) were calculated for each segment. Visualization of the changes in mortality rate of colorectal cancer death rates by 16 geographic areas in both sexes between 2000-2004 and 2009-2013 were also conducted. RESULTS: CRC mortality rates of men showed decreasing trend after increase in Daegu, Gyeongsangnam-do, and Chungcheongbuk-do between 2000 and 2013 based on the joinpoint model, while Gwangju, Jeollabuk-do, Jeollanam-do, and Gyeongsangbuk-do showed increase in CRC mortality during the same period. For women, CRC mortality of Seoul, Incheon, Daejeon, and Gyeongsangnam-do started to decrease in 2005, 2003, 2007, and 2006, respectively. The mortality rate for CRC in the eastern regions, which had relatively low rates of CRC among men in 2000 through 2004, reached a level similar to that in the northwestern regions of 2009 through 2013, while the highest CRC mortality rates in women was observed in Chungcheongbuk-do. CONCLUSIONS: Reduction in CRC mortality varied across 16 metropolitan cities and provinces in men, and the visualization pattern showed that the east side of South Korea had the least progress in mortality reduction.

Discordance between Physician and the General Public Perceptions of Prognostic Disclosure to Children with Serious Illness: a Korean Nationwide Study.

BACKGROUND: It is difficult to decide whether to inform the child of the incurable illness. We investigated attitudes of the general population and physicians toward prognosis disclosure to children and associated factors in Korea. METHODS: Physicians working in one of 13 university hospitals or the National Cancer Center and members of the general public responded to the questionnaire. The questionnaire consisted of the age appropriate for informing children about the prognosis and the reason why children should not be informed. This survey was conducted as part of research to identify perceptions of physicians and general public on the end-of-life care in Korea. RESULTS: A total of 928 physicians and 1,241 members of the general public in Korea completed the questionnaire. Whereas 92.7% of physicians said that children should be informed of their incurable illness, only 50.7% of the general population agreed. Physicians were also more likely to think that younger children should know about their poor prognosis compared with the general population. Physicians who opposed incurable illness disclosure suggested that children might not understand the situation, whereas the general public was primarily concerned that disclosure would exacerbate the disease. Physicians who were women or religious were more likely to want to inform children of their poor prognosis. In the general population, gender, education, comorbidity, and caregiver experience were related to attitude toward poor prognosis disclosure to children. CONCLUSION: Our findings indicate that physicians and the general public in Korea differ in their perceptions about informing children of poor prognosis.