advance directives, Delphi study, end-of-life, hospice, Korean advance directive, palliative care



  1. Kim, JinShil PhD, RN
  2. Kim, Shinmi PhD, RN
  3. Hong, Young Seon MD, PhD
  4. Hong, Sunwoo PhD, RN
  5. Kim, Kisook PhD, RN


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 [chi]2 = 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.