Professional Opinions on Advance Directives in Korea

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Abstract

A Korean advance directive (K-AD) draft was developed for establishment of a unified and evidence-based form of AD in Korea. Yet, it remains unknown whether this K-AD is culturally and practically compatible for employment in a clinical environment. Therefore, the aim of this study was to solicit professional opinions regarding this K-AD draft. Using a panel of experts in hospice and end-of-life (EOL) care, a 3-round Delphi study was conducted for evaluation of K-AD, composed of 16 specifics in 5 components, including introduction, a value statement, treatment options, proxy appointment, and stakeholders’ signatures. A consensus was determined: An item scored as important (≥4 on a 5-point Likert scale) among 75% of experts or content validity ratio of 0.59 or greater. Forty experts, 35% (n = 14) and 79% (n = 11) of previous-round participants, completed each round. Item evaluation did not differ across 3 rounds (Friedman χ2 = 0.00-6.00, P = .05-1.00). Experts reached a consensus on 5 K-AD components, all-encompassing. Among EOL treatment options, cardiopulmonary resuscitation, artificial ventilation, artificial feeding, and hospice care were determined for inclusion of the K-AD. Important-item content validity ratios ranged from 0.64 to 1.00. In conclusion, K-AD could be used as a vehicle to facilitate the decision-making process for EOL care.

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