Awareness, attitudes, and educational needs regarding the life-sustaining treatment decision-making act in Korea among healthcare providers and medical students: a comparative analysis

The Life-Sustaining Treatment (LST) Decision-Making Act is a South Korean law that aims to empower patients by providing them with more autonomy in end-of-life care decisions. However, there are significant differences between the law’s intentions and its implementation in clinical practice. It is essential to understand the perceptions of current and future healthcare professionals regarding LST in order to improve education, policy and patient-centred decision-making. This study aimed to compare the knowledge, attitudes and perceptions of LST among practicing healthcare professionals and medical students with clinical exposure to LST decision-making. A cross-sectional survey was conducted from August to December 2023 at a tertiary hospital in South Korea. The participants included healthcare providers (physicians, trainees, and nurses) and medical students with clinical experience. The survey assessed self-reported knowledge, attitudes, and perceptions of the LST Decision-Making Act. Group differences were analyzed using chi-square tests and logistic regression analyses. A total of 297 participants responded, including 204 healthcare providers and 93 medical students. Healthcare providers reported significantly higher self-perceived knowledge (88.7% vs. 52.7%) and confidence in participating in LST decisions (69.6% vs. 37.6%) than medical students (both p < 0.001). Both groups supported the ethical purpose of the Act and the need for advance directives, but their educational priorities differed. Providers emphasized procedural knowledge, whereas students prioritized ethical education. Perceptions regarding the timing, decision-makers, and withdrawal of treatment varied. Multivariate analysis revealed that professional roles were independently associated with perceived knowledge and competence. Many healthcare providers have reported systemic barriers, including complex documentation and limited patient or caregiver understanding. Notably, over 25% of providers indicated a continued reliance on Do-Not-Resuscitate forms because of procedural challenges. This study revealed substantial differences in perceptions of LST between healthcare providers and medical students. The findings underscore the need for improved educational programs and standardized protocols to effectively implement LST legislation and highlight significant implementation gaps.