Introduction
Decisions regarding life-sustaining treatment (LST) at the end of life are critical components of intensive care unit (ICU) management. Tools such as Physician Orders for Life-Sustaining Treatment (POLST) and advance directives (AD) are designed to uphold patient autonomy by anticipating patient preferences about terminal care. However, the effect of who signs these documents—the patient themselves or a surrogate decision-maker (usually a family member or legally authorized representative—on the patterns of care and resource utilization in ICU settings remains less well understood.
This nationwide population-based cohort study from South Korea aims to shed light on how the identity of the signatory (patient-determined vs. surrogate-determined) impacts the intensity of terminal care and hospitalization costs among adult ICU patients. Understanding these dynamics is essential in tailoring end-of-life care to respect patient wishes while avoiding overly aggressive and costly interventions that may not benefit the patient.
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