Preferences for Care near the End of Life according to Chronic Patients' Characteristics

Seonyoung Yun; Jiyeon Kang

doi:10.7475/KJAN.2013.25.1.207

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Preferences for Care near the End of Life according to Chronic Patients' Characteristics

Seonyoung Yun¹, Jiyeon Kang¹

Korean Journal of Adult Nursing 2013;25(2):207-218.
Published online: April 18, 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.1.207

¹Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Kang, Jiyeon Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-714, Korea Tel: +82-51-240-2871, Fax: +82-51-240-2920, E-mail: jykang@dau.ac.kr

• Received: November 29, 2012 • Accepted: April 23, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to explore the chronic patients' preferences for care near the end of life.
Methods
This is a descriptive survey research, with subjects of 161 outpatients with hypertension, diabetes mellitus or chronic renal failure.
Results
The majority of the subjects do not want meaningless life sustaining treatment and they report thinking positively about family or health care professional to participate in their end of life decision making process. Subjects reported preferring adequate pain management and spiritual support at the end of life. In regard to advance directives (ADs), those subjects with chronic disease report thinking positively about the necessity of ADs and its institutionalization. However, the subjects report not having the detailed information on the proper time and method of writing their ADs.
Conclusion
Based on these results, educational programs on end of life decision making for chronic patients need to be developed. Also, the nurse should try to reflect the opinion of chronic patients as much as possible when make an end-of-life decision.
Key Words: Chronic disease; Patients; Advance directives; Terminal care

Table 1.

General and Disease related Characteristics of Subjects (N=161)

Characteristics	Categories	n (%) or M±SD
Gender	Male	85 (52.8)
Gender	Female	76 (47.2)
Age (year)		58.90±9.84
	≤50	29 (18.0)
	51~60	62 (38.5)
	＞60	70 (43.5)
Marital status	Married	123 (76.4)
	Not married	11 (6.8)
	Divorced/bereaved	27 (16.8)
Religion	Yes	115 (71.5)
Religion	No	46 (28.5)
Education	≤Middle school	60 (37.3)
	High school	53 (32.9)
	≥College	48 (29.8)
Occupation	Yes	68 (42.2)
Occupation	No	93 (57.8)
Experience of acquaintances' death	Yes	69 (42.9)
Experience of acquaintances' death	No	92 (57.1)
Relationship with acquaintance∗	Parents	31 (44.9)
	Spouse	5 (7.2)
	Sibling	9 (13.1)
	Others	24 (34.8)
Caring experience for dying person	Yes	28 (17.4)
Caring experience for dying person	No	133 (82.6)
Relationship with dying person^†	Parents	17 (60.7)
	Spouse	3 (10.7)
	Sibling	5 (17.9)
	Others	3 (10.7)
Written will	Yes	7 (4.3)
Written will	No	154 (95.7)
Content of will	Funeral arrangements	4 (57.1)
Content of will	Inheritance matters Family	1 2 (14.3) (28.6)
Disease	Hypertension	60 (37.2)
	Diabetes	50 (31.1)
	Chronic renal failure	51 (31.7)
Duration of illness(year)	＜1	23 (14.3)
	1~5	57 (35.4)
	6~10	30 (18.6)
	＞10	51 (31.7)
Experience of ICU admission	Yes	35 (21.7)
Experience of ICU admission	No	126 (78.3)
Types of life sustaining treatment	Ventilator	4 (11.4)
	CPR	2 (5.7)
	Artificial nutrition	1 (2.9)
	Inotropic drugs	1 (2.9)
	Intubation	1 (2.9)
	Non	27 (77.1)

CPR=cardiopulmonary resuscitation; ICU=intensive care unit.

^†Missing cases excluded.

Table 2.

Advance Directives related Characteristics of Subjects (N=161)

Characteristics		Categories	n (%)
Experience	Meaning of ADs	Know well	35 (21.7)
		Heard about ADs, but do not know what a meaning	26 (16.1)
		Never heard of ADs	100 (62.1)
	Indirect experience about ADs	Yes	1 (0.6)
	Indirect experience about ADs	No	160 (99.4)
Attitude	Plan for preparing ADs	Yes	80 (49.7)
		No	25 (15.5)
		Decided yet	56 (34.8)
	Decision maker on ADs	Patients	118 (73.3)
		Health care provider	9 (5.6)
		Spouse	16 (9.9)
		Children	11 (6.8)
		Others	7 (4.4)
	Appropriate timing for preparing ADs	Whenever healthy	56 (34.8)
		Take a serious turn	43 (26.7)
		Diagnosed as terminally ill	21 (13.0)
		Admitted to hospital	18 (11.2)
		Admitted to ICU	11 (6.8)
		Near death	10 (6.2)
		Do not know	2 (1.2)
	Types of preparing ADs	Verbal	74 (46.0)
		Written document	65 (40.4)
		Recording	11 (6.8)
		Do not know	11 (6.8)
	Necessity of ADs	Strongly agree	20 (12.4)
		Agree	123 (76.4)
		Disagree	15 (9.3)
		Strongly disagree	3 (1.9)
	Necessity of legislation	Agree	87 (54.0)
		Disagree	20 (12.4)
		Do not know	54 (33.5)

ADs=advance directives; ICU=intensive care unit.

Table 3.

Preferences for Care Near the End of Life among Patients with Chronic Disease (N=161)

Categories	Items	M±SD
Autonomous decision making	If my heart stops, I do not want CPR	3.56±1.04
	I do not want to be fed artificially	2.34±0.98
	If I can no longer breathe on my own, I do not want to be connected to a breathing machine	3.78±0.94
	I want to let nature guide my dying and I do not want my life to be artificially prolonged in any way	3.89±0.81
	If my heart stops, I want to be CPR	2.42±1.03
	I want to be fed through a tube when I can no longer take food or drink normally	3.66±0.93
	I want to let God guide my dying and I do not want my life to be artificially prolonged in any way	3.80±0.86
	If I can no longer breathe on my own, I want to be connected to a breathing machine	2.28±0.96
	Subtotal	2.28±0.76
Decision making by health care professional	I want health care providers to make all care decisions	3.14±1.02
	Health care providers knows what is best for me at this time and I want to make all decisions about my care	3.32±0.99
	I want my doctor to make health care decision	3.19±1.02
	Health care providers, because they are experts, should have the final word in decisions about my care	3.42±0.92
	Subtotal	3.27±0.88
Spirituality	I want my spiritual beliefs to guide my preferences	2.98±1.09
	I want my religious beliefs to guide my preferences care at this time	2.87±1.09
	I want nurses who attend to my emotional and spiritual needs as my physical needs	3.65±0.73
	I want to be able to talk to someone about my spiritual needs	2.90±1.06
	I want have hospice care	3.50±0.90
	I want to my nurse to talk to me about my spiritual needs	2.79±1.02
	Subtotal	3.11±0.76
Family input to decision making	I want my family to make all decisions about my care when I can no longer verbally express my desires	3.66±0.90
	I want to my family to have the final word in decisions about my care	3.57±0.92
	I want my family to be involved in my health care decisions	3.91±0.57
	I want all explanations given to my family so they can decide on my care	3.71±0.85
	My family knows what is best for me at this time and I want to make all decisions about my care	3.57±0.91
	Subtotal	3.68±0.73
Pain	I want to be free of pain even if it hastens my death	4.04±0.60
	I want health care providers to deal with the details of my care	3.95±0.47
	I want an early death instead of suffering	3.78±0.79
	Subtotal	3.92±0.44

CPR=cardiopulmonary resuscitation.

Table 4.

Preference for Care Near the End of Life according to Characteristic of Subjects (N=161)

Characteristics	Categories	Autonomous decision making			Decision making by health care professional			Spirituality			Family input to decision making			Pain
Characteristics	Categories	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p
Gender	Male	2.36±0.77	1.37	.174	3.41±0.89	2.27	.024	3.01±0.77	-1.94	.054	3.76±0.69	1.34	.182	3.90±0.50	-0.66	.513
Gender	Female	2.19±0.73			3.10±0.85			3.24±0.73			3.60±0.77			3.95±0.36
Age (year)	＜50	2.40±0.78	0.91	.364	2.95±0.82	-2.17	.031	3.15±0.80	0.26	.797	3.60±0.69	-0.72	.478	3.75±0.65	-1.72	.096
Age (year)	≥50	2.26±0.75			3.34±0.88			3.11±0.75			3.70±0.74			3.96±0.37
Religion	Yes	2.26±0.79	-0.78	.436	3.26±0.89	-0.09	.927	3.34±0.75	8.27	＜.001	3.69±0.76	0.12	.908	3.99±0.43	2.91	.004
Religion	No	2.36±0.66			3.28±0.88			2.56±0.42			3.67±0.65			3.77±0.42
Education	≤Middle school	2.28±0.72	0.54	.581	3.21±0.91	0.18	.832	3.08±0.64	0.14	.866	3.72±0.70	0.24	.790	3.98±0.34	0.74	.479
	≥High school	2.21±0.69			3.31±0.89			3.11±0.72			3.63±0.79			3.89±0.47
	≥College	2.37±0.87			3.29±0.86			3.16±0.93			3.70±0.70			3.90±0.51
Occupation	Yes	2.36±0.82	1.14	.258	3.43±0.87	2.02	.045	3.15±0.83	0.52	.607	3.69±0.73	2.02	.886	3.95±0.47	0.56	.576
Occupation	No	2.23±0.71			3.15±0.88			3.09±0.71			3.68±073			3.91±0.42
Indirect experience about death	Yes	2.24±0.74	-0.69	.491	3.29±0.89	0.28	.778	3.18±0.77	0.99	.322	3.81±0.68	1.93	.055	3.97±0.39	2.25	.234
Indirect experience about death	No	2.32±0.77			3.25±0.88			3.06±0.75			3.59±0.75			3.89±0.47
Living will	Yes	1.98±0.86	-1.08	.280	3.61±1.24	1.04	.299	4.19±0.71	4.01	＜.001	4.14±0.78	4.01	.089	4.33±0.61	-0.14	.011
Living will	No	2.30±0.75			3.25±0.87			3.07±0.73			3.66±0.72			3.90±0.42
Disease	Hypertension	2.25±0.79	0.14	.874	3.12±0.91	1.58	.209	3.22±0.79	3.01	.520	3.55±0.81	1.87	.158	4.00±0.38	1.30	.029
	Diabetes	2.28±0.82			3.29±0.94			3.21±0.76			3.72±0.75			3.97±0.43		(a＞c)^†
	CRF	2.33±0.65			3.42±0.78			2.90±0.69			3.81±0.58			3.79±0.48
Period (year)	＜10	2.19±0.69	-2.24	.028	3.20±0.89	-1.47	.144	3.02±0.76	-2.33	.021	3.69±0.74	0.26	.798	3.98±0.38	3.61	.027
Period (year)	≥10	2.49±0.85			3.42±0.87			3.32±0.74			3.66±0.71			3.80±0.53
Experience of ICU admission	Yes	2.60±0.83	2.85	.005	3.36±0.86	0.68	.497	3.12±0.68	0.08	.938	3.91±0.47	0.08	.006	3.91±0.37	1.20	.890
Experience of ICU admission	No	2.20±0.71			3.24±0.89			3.11±0.78			3.62±0.78			3.92±0.46

CRF=Chronic Renal Failure; ICU=Intensive Care Unit.

^†Scheffé's multiple comparison test.

Table 5.

Comparison of PCEOL according to Necessity and Main Agent of ADs (N=161)

Categories	Necessity of ADs		t	p	Main agent of ADs		t	p
	Agree	Disagree			Self	Others
	M±SD	M±SD			M±SD	M±SD
Autonomous decision making	2.28±0.72	2.30±1.01	-0.12	.903	2.19±0.68	2.53±0.89	-2.26	.028
Decision making by health care professional	3.20±0.87	3.76±0.89	-2.58	.011	3.10±0.89	3.72±0.70	-4.66	＜.001
Spirituality	3.11±0.75	3.16±0.88	-0.25	.802	3.20±0.76	2.86±0.70	2.66	.009
Family	3.69±0.70	3.68±0.97	0.03	.975	3.59±0.76	3.93±0.58	-2.97	.004
Pain	3.92±0.43	3.96±0.53	-0.41	.686	3.92±0.43	3.93±0.47	-0.12	.905

PCEOL=preference for care near the end of life; ADs=advance directives.

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Preferences for Care near the End of Life according to Chronic Patients' Characteristics

Korean J Adult Nurs. 2013;25(2):207-218. Published online April 30, 2013

DOI: https://doi.org/10.7475/kjan.2013.25.1.207

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Preferences for Care near the End of Life according to Chronic Patients' Characteristics

Korean J Adult Nurs. 2013;25(2):207-218. Published online April 30, 2013

DOI: https://doi.org/10.7475/kjan.2013.25.1.207

Preferences for Care near the End of Life according to Chronic Patients' Characteristics

Table 1.

General and Disease related Characteristics of Subjects (N=161)

Characteristics	Categories	n (%) or M±SD
Gender	Male	85 (52.8)
Gender	Female	76 (47.2)
Age (year)		58.90±9.84
	≤50	29 (18.0)
	51~60	62 (38.5)
	＞60	70 (43.5)
Marital status	Married	123 (76.4)
	Not married	11 (6.8)
	Divorced/bereaved	27 (16.8)
Religion	Yes	115 (71.5)
Religion	No	46 (28.5)
Education	≤Middle school	60 (37.3)
	High school	53 (32.9)
	≥College	48 (29.8)
Occupation	Yes	68 (42.2)
Occupation	No	93 (57.8)
Experience of acquaintances' death	Yes	69 (42.9)
Experience of acquaintances' death	No	92 (57.1)
Relationship with acquaintance∗	Parents	31 (44.9)
	Spouse	5 (7.2)
	Sibling	9 (13.1)
	Others	24 (34.8)
Caring experience for dying person	Yes	28 (17.4)
Caring experience for dying person	No	133 (82.6)
Relationship with dying person^†	Parents	17 (60.7)
	Spouse	3 (10.7)
	Sibling	5 (17.9)
	Others	3 (10.7)
Written will	Yes	7 (4.3)
Written will	No	154 (95.7)
Content of will	Funeral arrangements	4 (57.1)
Content of will	Inheritance matters Family	1 2 (14.3) (28.6)
Disease	Hypertension	60 (37.2)
	Diabetes	50 (31.1)
	Chronic renal failure	51 (31.7)
Duration of illness(year)	＜1	23 (14.3)
	1~5	57 (35.4)
	6~10	30 (18.6)
	＞10	51 (31.7)
Experience of ICU admission	Yes	35 (21.7)
Experience of ICU admission	No	126 (78.3)
Types of life sustaining treatment	Ventilator	4 (11.4)
	CPR	2 (5.7)
	Artificial nutrition	1 (2.9)
	Inotropic drugs	1 (2.9)
	Intubation	1 (2.9)
	Non	27 (77.1)

CPR=cardiopulmonary resuscitation; ICU=intensive care unit.

^†Missing cases excluded.

Table 2.

Advance Directives related Characteristics of Subjects (N=161)

Characteristics		Categories	n (%)
Experience	Meaning of ADs	Know well	35 (21.7)
		Heard about ADs, but do not know what a meaning	26 (16.1)
		Never heard of ADs	100 (62.1)
	Indirect experience about ADs	Yes	1 (0.6)
	Indirect experience about ADs	No	160 (99.4)
Attitude	Plan for preparing ADs	Yes	80 (49.7)
		No	25 (15.5)
		Decided yet	56 (34.8)
	Decision maker on ADs	Patients	118 (73.3)
		Health care provider	9 (5.6)
		Spouse	16 (9.9)
		Children	11 (6.8)
		Others	7 (4.4)
	Appropriate timing for preparing ADs	Whenever healthy	56 (34.8)
		Take a serious turn	43 (26.7)
		Diagnosed as terminally ill	21 (13.0)
		Admitted to hospital	18 (11.2)
		Admitted to ICU	11 (6.8)
		Near death	10 (6.2)
		Do not know	2 (1.2)
	Types of preparing ADs	Verbal	74 (46.0)
		Written document	65 (40.4)
		Recording	11 (6.8)
		Do not know	11 (6.8)
	Necessity of ADs	Strongly agree	20 (12.4)
		Agree	123 (76.4)
		Disagree	15 (9.3)
		Strongly disagree	3 (1.9)
	Necessity of legislation	Agree	87 (54.0)
		Disagree	20 (12.4)
		Do not know	54 (33.5)

ADs=advance directives; ICU=intensive care unit.

Table 3.

Preferences for Care Near the End of Life among Patients with Chronic Disease (N=161)

Categories	Items	M±SD
Autonomous decision making	If my heart stops, I do not want CPR	3.56±1.04
	I do not want to be fed artificially	2.34±0.98
	If I can no longer breathe on my own, I do not want to be connected to a breathing machine	3.78±0.94
	I want to let nature guide my dying and I do not want my life to be artificially prolonged in any way	3.89±0.81
	If my heart stops, I want to be CPR	2.42±1.03
	I want to be fed through a tube when I can no longer take food or drink normally	3.66±0.93
	I want to let God guide my dying and I do not want my life to be artificially prolonged in any way	3.80±0.86
	If I can no longer breathe on my own, I want to be connected to a breathing machine	2.28±0.96
	Subtotal	2.28±0.76
Decision making by health care professional	I want health care providers to make all care decisions	3.14±1.02
	Health care providers knows what is best for me at this time and I want to make all decisions about my care	3.32±0.99
	I want my doctor to make health care decision	3.19±1.02
	Health care providers, because they are experts, should have the final word in decisions about my care	3.42±0.92
	Subtotal	3.27±0.88
Spirituality	I want my spiritual beliefs to guide my preferences	2.98±1.09
	I want my religious beliefs to guide my preferences care at this time	2.87±1.09
	I want nurses who attend to my emotional and spiritual needs as my physical needs	3.65±0.73
	I want to be able to talk to someone about my spiritual needs	2.90±1.06
	I want have hospice care	3.50±0.90
	I want to my nurse to talk to me about my spiritual needs	2.79±1.02
	Subtotal	3.11±0.76
Family input to decision making	I want my family to make all decisions about my care when I can no longer verbally express my desires	3.66±0.90
	I want to my family to have the final word in decisions about my care	3.57±0.92
	I want my family to be involved in my health care decisions	3.91±0.57
	I want all explanations given to my family so they can decide on my care	3.71±0.85
	My family knows what is best for me at this time and I want to make all decisions about my care	3.57±0.91
	Subtotal	3.68±0.73
Pain	I want to be free of pain even if it hastens my death	4.04±0.60
	I want health care providers to deal with the details of my care	3.95±0.47
	I want an early death instead of suffering	3.78±0.79
	Subtotal	3.92±0.44

CPR=cardiopulmonary resuscitation.

Table 4.

Preference for Care Near the End of Life according to Characteristic of Subjects (N=161)

Characteristics	Categories	Autonomous decision making			Decision making by health care professional			Spirituality			Family input to decision making			Pain
Characteristics	Categories	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p
Gender	Male	2.36±0.77	1.37	.174	3.41±0.89	2.27	.024	3.01±0.77	-1.94	.054	3.76±0.69	1.34	.182	3.90±0.50	-0.66	.513
Gender	Female	2.19±0.73			3.10±0.85			3.24±0.73			3.60±0.77			3.95±0.36
Age (year)	＜50	2.40±0.78	0.91	.364	2.95±0.82	-2.17	.031	3.15±0.80	0.26	.797	3.60±0.69	-0.72	.478	3.75±0.65	-1.72	.096
Age (year)	≥50	2.26±0.75			3.34±0.88			3.11±0.75			3.70±0.74			3.96±0.37
Religion	Yes	2.26±0.79	-0.78	.436	3.26±0.89	-0.09	.927	3.34±0.75	8.27	＜.001	3.69±0.76	0.12	.908	3.99±0.43	2.91	.004
Religion	No	2.36±0.66			3.28±0.88			2.56±0.42			3.67±0.65			3.77±0.42
Education	≤Middle school	2.28±0.72	0.54	.581	3.21±0.91	0.18	.832	3.08±0.64	0.14	.866	3.72±0.70	0.24	.790	3.98±0.34	0.74	.479
	≥High school	2.21±0.69			3.31±0.89			3.11±0.72			3.63±0.79			3.89±0.47
	≥College	2.37±0.87			3.29±0.86			3.16±0.93			3.70±0.70			3.90±0.51
Occupation	Yes	2.36±0.82	1.14	.258	3.43±0.87	2.02	.045	3.15±0.83	0.52	.607	3.69±0.73	2.02	.886	3.95±0.47	0.56	.576
Occupation	No	2.23±0.71			3.15±0.88			3.09±0.71			3.68±073			3.91±0.42
Indirect experience about death	Yes	2.24±0.74	-0.69	.491	3.29±0.89	0.28	.778	3.18±0.77	0.99	.322	3.81±0.68	1.93	.055	3.97±0.39	2.25	.234
Indirect experience about death	No	2.32±0.77			3.25±0.88			3.06±0.75			3.59±0.75			3.89±0.47
Living will	Yes	1.98±0.86	-1.08	.280	3.61±1.24	1.04	.299	4.19±0.71	4.01	＜.001	4.14±0.78	4.01	.089	4.33±0.61	-0.14	.011
Living will	No	2.30±0.75			3.25±0.87			3.07±0.73			3.66±0.72			3.90±0.42
Disease	Hypertension	2.25±0.79	0.14	.874	3.12±0.91	1.58	.209	3.22±0.79	3.01	.520	3.55±0.81	1.87	.158	4.00±0.38	1.30	.029
	Diabetes	2.28±0.82			3.29±0.94			3.21±0.76			3.72±0.75			3.97±0.43		(a＞c)^†
	CRF	2.33±0.65			3.42±0.78			2.90±0.69			3.81±0.58			3.79±0.48
Period (year)	＜10	2.19±0.69	-2.24	.028	3.20±0.89	-1.47	.144	3.02±0.76	-2.33	.021	3.69±0.74	0.26	.798	3.98±0.38	3.61	.027
Period (year)	≥10	2.49±0.85			3.42±0.87			3.32±0.74			3.66±0.71			3.80±0.53
Experience of ICU admission	Yes	2.60±0.83	2.85	.005	3.36±0.86	0.68	.497	3.12±0.68	0.08	.938	3.91±0.47	0.08	.006	3.91±0.37	1.20	.890
Experience of ICU admission	No	2.20±0.71			3.24±0.89			3.11±0.78			3.62±0.78			3.92±0.46

CRF=Chronic Renal Failure; ICU=Intensive Care Unit.

^†Scheffé's multiple comparison test.

Table 5.

Comparison of PCEOL according to Necessity and Main Agent of ADs (N=161)

Categories	Necessity of ADs		t	p	Main agent of ADs		t	p
	Agree	Disagree			Self	Others
	M±SD	M±SD			M±SD	M±SD
Autonomous decision making	2.28±0.72	2.30±1.01	-0.12	.903	2.19±0.68	2.53±0.89	-2.26	.028
Decision making by health care professional	3.20±0.87	3.76±0.89	-2.58	.011	3.10±0.89	3.72±0.70	-4.66	＜.001
Spirituality	3.11±0.75	3.16±0.88	-0.25	.802	3.20±0.76	2.86±0.70	2.66	.009
Family	3.69±0.70	3.68±0.97	0.03	.975	3.59±0.76	3.93±0.58	-2.97	.004
Pain	3.92±0.43	3.96±0.53	-0.41	.686	3.92±0.43	3.93±0.47	-0.12	.905

PCEOL=preference for care near the end of life; ADs=advance directives.

Table 1. General and Disease related Characteristics of Subjects (N=161)

CPR=cardiopulmonary resuscitation; ICU=intensive care unit.

†

Missing cases excluded.

Table 2. Advance Directives related Characteristics of Subjects (N=161)

ADs=advance directives; ICU=intensive care unit.

Table 3. Preferences for Care Near the End of Life among Patients with Chronic Disease (N=161)

CPR=cardiopulmonary resuscitation.

Table 4. Preference for Care Near the End of Life according to Characteristic of Subjects (N=161)

CRF=Chronic Renal Failure; ICU=Intensive Care Unit.

†

Scheffé's multiple comparison test.

Table 5. Comparison of PCEOL according to Necessity and Main Agent of ADs (N=161)

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