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Background@#Biogenetic causal explanations of mental disorders are commonly used for public education and campaigns. However, the influence of biogenetic explanations on the ideas about and attitudes toward mental illness is unclear. We examined the influence of biogenetic explanations on attitudes toward mental disorders using a meta-analytic method accompanied by subgroup analyses. @*Methods@#The protocol for this meta-analysis was registered in PROSPERO (CRD42020158656) in March 2020. Experimental and correlational studies were analyzed separately. Five outcome measures related to attitudes toward mental disorders were included: ‘attitude toward helpseeking,’ ‘blame,’ ‘perceived dangerousness,’ ‘prognostic pessimism,’ and ‘social distance.’ Subgroup analyses were performed for the type of mental disorder, population, and geographic region for which a biogenetic explanation was provided. @*Results@#A total of 44 studies were included, of which 24 were experimental and 20 were correlational. A positive attitude toward help-seeking was associated with having a biogenetic concept (d = 0.43; 95% confidence interval [CI], 0.18 to 0.67; P < 0.001) in general population and in Eastern countries in particular. Although a biogenetic explanation was associated with a decreased level of blame (d = −0.20; 95% CI, −0.38 to −0.02; P = 0.029) in the general population, it was also associated with significantly higher levels of perceived dangerousness (d = 0.13; 95% CI, 0.03 to 0.23; P = 0.008). A tendency toward a higher level of prognostic pessimism and social distance was associated with a biogenetic concept of mental disorders although there was no statistical significance. @*Conclusion@#Having a biogenetic concept of the cause of mental disorders was related with a positive attitude toward help-seeking, particularly in the general population and individuals living in Eastern countries. Providing a biogenetic explanation decreased blame toward individuals with mental illness but was associated with increased perceived dangerousness and prognostic pessimism. Therefore, although a biogenetic explanation use of mental health services, it should be carefully applied to avoid an increase in negative thoughts, such as that mental illness is biologically irreversible and untreatable.promotes public
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Purpose@#Patients with pain conditions may experience depression that greatly complicates treatment. In this study, we examined risk factors for depression in patients with pain conditions and associations between depression and long-term mortality in such patients. @*Materials and Methods@#Data from the National Health Insurance Service database in South Korea were used in this cohort study. A total of 2.5% of adult patients diagnosed with pain conditions in 2010 were selected using a stratified random sampling technique and included for analysis. We performed multivariate logistic regression modelling to identify risk factors associated with depression and multivariate Cox regression modelling to determine whether depression is associated with 10-year survival outcomes in patients with pain conditions. @*Results@#In total, data from 1808043 patients with pain conditions in 2010 were analyzed. Among them, 70148 (3.9%) patients had depression. Multivariate logistic regression modelling identified older age, comorbidities, analgesics, female sex, living in an urban area, and other underlying psychiatric morbidities as potential risk factors for depression in patients with pain conditions. Multivariate Cox regression revealed that 10-year all-cause mortality in patients with depression was 1.13-fold (hazard ratio, 1.13;95% confidence interval, 1.11–1.16; p<0.001) higher than that in patients without depression and pain conditions. @*Conclusion@#We identified a few potential risk factors for depression among South Korean patients with pain conditions. Depression was associated with elevated 10-year all-cause mortality in patients with pain conditions.
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Objective@#Chronic pain increases the risk of suicide because it is often accompanied by depressive symptoms. However, the existing information regarding suicidal thinking in patients with chronic pain such as spinal conditions is insufficient. We aimed to examine the prevalence of suicidal thinking and the factors associated with it among patients with spinal conditions. @*Methods@#Data from the National Health Insurance Service database in South Korea were used in this population-based, cross-sectional study, and 2.5% of adult patients diagnosed with spinal conditions (low back pain and/or neck pain) between 2018 and 2019 were selected using a stratified random sampling technique. Patient Health Questionnaire–9 was used to determine the presence of suicidal thoughts and depressive symptoms. @*Results@#33,171 patients with spinal conditions were included in this study. Among them, 5.9% had suicidal thinking and 20.7% had depressive symptoms. In the multivariable logistic regression model, old age, male sex, and employment were associated with a decreased prevalence of suicidal thinking. Current smokers, previous smokers, medical aid program recipients, and patients with mild-to-moderate or severe disability showed increased suicidal thinking. Underlying depression, bipolar disorder, insomnia disorder, and substance abuse were also associated with increased suicidal thinking. @*Conclusion@#In South Korea, 5.9% and 20.7% of patients with spinal conditions had suicidal thoughts and depressive symptoms, respectively. Some factors were associated with an increased prevalence of suicidal thoughts among patients with spinal conditions. Our results suggest that screening for these factors can help prevent suicide in patients with spinal conditions.
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Background@#Clinical ethics support is a form of preventive ethics aimed at mediating ethicsrelated conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018. @*Methods@#A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultationrelated documents. @*Results@#A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/ treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage. @*Conclusion@#The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.
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Background@#Healthcare professionals often experience moral distress while providing endof-life care. This study explored how physicians and nurses experienced moral distress when they cared for critically and terminally ill patients in tertiary hospitals in South Korea. @*Methods@#This study used semi-structured in-depth interviews. A total of 22 people in two tertiary hospitals were interviewed, nine (40.9%) of which were physicians and 13 (59.1%) were nurses. The recorded interview files and memos were analyzed using grounded theory. @*Results@#Most physicians and nurses encountered similar feelings of anger, helplessness, and burden owing to a lack of appropriate resources for end-of-life care. However, the factors and contexts of their moral distress differed. Nurses mainly addressed poorly organized end-of-life care, intensive labor conditions without support for nurses, and providing care without participation in decision-making. Meanwhile, physicians addressed the prevailing misperceptions on end-of-life care, communication failure between physicians owing to hierarchy and fragmented disciplines, the burden of responsibility in making difficult decisions, and the burden of resource allocation. @*Conclusion@#Differences in moral distress between physicians and nurses leave them isolated and can affect communication regarding healthcare. Mutual understanding between job disciplines will enhance their communication and help resolve conflicts in end-of-life care.
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Objectives@#：This study intends to assess the associations among perceived stigma at the time of infection, coping strategies adopted 12 months later and depressive and posttraumatic symptoms 24 months later in Middle Eastern Respiratory Syndrome (MERS) survivors. @*Methods@#：A nationwide cohort study was conducted on 63 survivors of 2015 MERS outbreak. Demographic data, illness severity of MERS, depression and posttraumatic stress symptoms, coping strategies and MERS-related stigma were collected 12 and 24 months after the MERS outbreak, respectively. @*Results@#：Higher levels of perceived stigma at the time of outbreak were associated with higher levels of dysfunctional coping strategies after 12 months (p=0.003) and more severe depressive (p=0.058) and posttraumatic stress symptoms (p=0.011) after 24 months. Moreover, higher levels of dysfunctional coping strategies after 12 months were significantly associated with more severe depressive (p=0.002) and posttraumatic stress symptoms (p<0.001) after 24 months. @*Conclusions@#：Social stigma against people who have contracted an emerging infectious disease can leave a negative impact on the mental health of the survivors in the long term. In case of novel pandemics in the future, promptrectification of stigma and promotion of adaptive coping strategies in survivors are needed.
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Background@#Throughout the coronavirus disease 2019 (COVID-19) pandemic, not only medical personnel but also paramedics or emergency medical technicians (EMT) have faced multiple physical and psychological challenges while performing their duties. The current study aimed to evaluate the psychological effects of managing patients with COVID-19 on the paramedics and EMT. @*Materials and Methods@#A survey targeting paramedics and EMT in Korea was conducted in December 2020. An official letter requesting participation and with the link to an onlinebased survey was sent to the Public Emergency Medical Services. Only one response was accepted from each participant. @*Results@#A total of 326 paramedics and EMT responded to the survey. Among them, 66.3% (216/326) had experience in managing patients with COVID-19. No differences in the distribution of sex, age, working area, duration of working experience, and underlying comorbidities were observed between those who did (COVID-19 group) and did not (nonCOVID-19 group) experience managing patients with COVID-19. The percentage of participants who showed severe posttraumatic stress disorder (PTSD) symptoms was significantly higher in the COVID group than in the non-COVID group (11.1% vs. 3.6%P = 0.029). The participants in the COVID group had a significantly higher mean Global Assessment of Recent Stress Scale score than those in the non-COVID group (18.7 ± 11.1 vs. 16.1 ± 9.9, P = 0.042). The proportion of paramedics and EMT willing to leave their job if given a chance was higher in the COVID group than the non-COVID group (24.1% vs. 9.1%, P = 0.001). Additionally, paramedics and EMT in the COVID group tended to show concern regarding exposure to COVID-19 infection. @*Conclusion@#The experience of managing patients with COVID-19 resulted in psychological distress among paramedics and EMT in Korea.
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Objective@#The Reading the Mind in the Eyes Test (RMET) was developed by using Caucasian eyes, which may not be appropriate to be used in Korean. The aims of the present study were 1) to develop a Korean version of the RMET (K-RMET) by using Korean eye stimuli and 2) to examine the psychometric properties of the Korean-translated version of the RMET and the K-RMET. @*Methods@#Thirty-six photographs of Korean eyes were selected. A total of 196 (101 females) healthy subjects were asked to take the Korean-translated version of the RMET and K-RMET. To assess internal consistency reliability, Cronbach’s alpha coefficients were computed, and test–retest reliability was assessed by the intraclass correlation coefficient (ICC) and Bland-Altman plots. Confirmatory factor analysis (CFA) and item analysis were also conducted. @*Results@#Internal consistency, measured by Cronbach’s alpha, was 0.542 for the Korean-translated version of the RMET, and 0.540 for the K-RMET. Test–retest reliability (n=25), measured by the ICC, was 0.787 for the Korean-translated version of the RMET, and 0.758 for the K-RMET. In CFA, the assumed single and 3-factor model fit indices were not good in the both types of RMETs. There was difficulty in discrimination in nine items of the Korean-translated version of the RMET and 10 items of the K-RMET. @*Conclusion@#The psychometric properties of both the Korean-translated version of the RMET and the K-RMET are acceptable. Both tests are applicable to the clinical population, as well as the general population in Korea.
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Objectives@#Social function deficit is known as a core feature of schizophrenia. This study aimed to investigate differences in empathic tendencies and theory of mind (ToM) skills between healthy controls and young individuals with schizophrenia, and to examine the associations between empathic tendencies, ToM skills and schizotypy, and executive function in schizophrenia. @*Methods@#Thirty patients with schizophrenia and 30 healthy controls were enrolled and assessed using the interpersonal relationship index (IRI; perspective taking, fantasy, empathic concern, and personal distress subscales), ToM-Picture Story Task (ToM-PST; sequence and cognitive questionnaire), Wisconsin schizotypy scale (revised physical anhedonia and perceptual aberration), and Stroop tests for empathic tendencies, ToM skills, schizotypy, and executive function. @*Results@#In individuals with schizophrenia, the IRI for perspective taking and ToM-PST score for cognitive function were lower, and the IRI for personal distress was higher than those in healthy controls. The IRIs for perspective taking and fantasy were related to revised physical anhedonia, and that for empathic concern was associated with revised physical anhedonia and perceptual aberration. The ToM-PST score for sequence was associated with the Stroop test score for schizophrenia. @*Conclusion@#These findings indicate deficits in empathic tendencies and ToM skills, which may be independently and primarily associated with schizotypy and executive function in young individuals with schizophrenia.
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In the era of coronavirus disease 2019 (COVID-19), social distancing and strict visitation policies at hospitals have made it difficult for medical staff to provide high-quality endof-life (EOL) care to dying patients and their families. There are various issues related to EOL care, including psychological problems of patients and their families, difficulties in EOL decision-making, the complicated grief of the bereaved family, moral distress, and exhaustion of medical staff. In relation to these issues, we aimed to discuss practical considerations in providing high-quality EOL care in the COVID-19 pandemic. First, medical staff should discuss advance care planning as early as possible and use the parallel planning strategy. Second, medical staff should play a role in facilitating patient-family communication. Third, medical staff should actively and proactively evaluate and alleviate dying patients’ symptoms using non-verbal communication. Lastly, medical staff should provide care for family members of the dying patient, who may be particularly vulnerable to postbereavement problems in the COVID-19 era. Establishing a system of screening highrisk individuals for complicated grief and connecting them to bereavement support services might be considered. Despite the challenging and limited environment, providing EOL care is essential for patients to die with dignity in peace and for the remaining family to return to life after the loved one’s death. Efforts considering the practical issues faced by all medical staff and healthcare institutions caring for dying patients should be made.
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Objective@#The Reading the Mind in the Eyes Test (RMET) was developed by using Caucasian eyes, which may not be appropriate to be used in Korean. The aims of the present study were 1) to develop a Korean version of the RMET (K-RMET) by using Korean eye stimuli and 2) to examine the psychometric properties of the Korean-translated version of the RMET and the K-RMET. @*Methods@#Thirty-six photographs of Korean eyes were selected. A total of 196 (101 females) healthy subjects were asked to take the Korean-translated version of the RMET and K-RMET. To assess internal consistency reliability, Cronbach’s alpha coefficients were computed, and test–retest reliability was assessed by the intraclass correlation coefficient (ICC) and Bland-Altman plots. Confirmatory factor analysis (CFA) and item analysis were also conducted. @*Results@#Internal consistency, measured by Cronbach’s alpha, was 0.542 for the Korean-translated version of the RMET, and 0.540 for the K-RMET. Test–retest reliability (n=25), measured by the ICC, was 0.787 for the Korean-translated version of the RMET, and 0.758 for the K-RMET. In CFA, the assumed single and 3-factor model fit indices were not good in the both types of RMETs. There was difficulty in discrimination in nine items of the Korean-translated version of the RMET and 10 items of the K-RMET. @*Conclusion@#The psychometric properties of both the Korean-translated version of the RMET and the K-RMET are acceptable. Both tests are applicable to the clinical population, as well as the general population in Korea.
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Objectives@#Social function deficit is known as a core feature of schizophrenia. This study aimed to investigate differences in empathic tendencies and theory of mind (ToM) skills between healthy controls and young individuals with schizophrenia, and to examine the associations between empathic tendencies, ToM skills and schizotypy, and executive function in schizophrenia. @*Methods@#Thirty patients with schizophrenia and 30 healthy controls were enrolled and assessed using the interpersonal relationship index (IRI; perspective taking, fantasy, empathic concern, and personal distress subscales), ToM-Picture Story Task (ToM-PST; sequence and cognitive questionnaire), Wisconsin schizotypy scale (revised physical anhedonia and perceptual aberration), and Stroop tests for empathic tendencies, ToM skills, schizotypy, and executive function. @*Results@#In individuals with schizophrenia, the IRI for perspective taking and ToM-PST score for cognitive function were lower, and the IRI for personal distress was higher than those in healthy controls. The IRIs for perspective taking and fantasy were related to revised physical anhedonia, and that for empathic concern was associated with revised physical anhedonia and perceptual aberration. The ToM-PST score for sequence was associated with the Stroop test score for schizophrenia. @*Conclusion@#These findings indicate deficits in empathic tendencies and ToM skills, which may be independently and primarily associated with schizotypy and executive function in young individuals with schizophrenia.
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In the era of coronavirus disease 2019 (COVID-19), social distancing and strict visitation policies at hospitals have made it difficult for medical staff to provide high-quality endof-life (EOL) care to dying patients and their families. There are various issues related to EOL care, including psychological problems of patients and their families, difficulties in EOL decision-making, the complicated grief of the bereaved family, moral distress, and exhaustion of medical staff. In relation to these issues, we aimed to discuss practical considerations in providing high-quality EOL care in the COVID-19 pandemic. First, medical staff should discuss advance care planning as early as possible and use the parallel planning strategy. Second, medical staff should play a role in facilitating patient-family communication. Third, medical staff should actively and proactively evaluate and alleviate dying patients’ symptoms using non-verbal communication. Lastly, medical staff should provide care for family members of the dying patient, who may be particularly vulnerable to postbereavement problems in the COVID-19 era. Establishing a system of screening highrisk individuals for complicated grief and connecting them to bereavement support services might be considered. Despite the challenging and limited environment, providing EOL care is essential for patients to die with dignity in peace and for the remaining family to return to life after the loved one’s death. Efforts considering the practical issues faced by all medical staff and healthcare institutions caring for dying patients should be made.
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Background@#During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. @*Methods@#From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. @*Results@#Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. @*Conclusion@#Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.
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Purpose@#This study aimed to investigate difficulties doctors experience during life-sustaining treatment (LST) discussion with seriously ill patients and their families after enactment of the LST Decisions Act in February 2018. @*Materials and Methods@#A cross-sectional survey was conducted in a tertiary hospital in the Republic of Korea in August 2019. Six hundred eighty-six doctors who care for seriously ill patients were given a structured questionnaire, and difficulties during the discussion were examined. @*Results@#One hundred thirty-two doctors completed the questionnaire. Eighty-five percent answered they treat cancer patients. Most (86.4%) experienced considerable difficulties during LST discussions (mean score, 7.4±1.6/10). The two most common difficulties were communication with patients and family and determining when to discuss LST. Two-thirds of doctors found direct discussions with the patient difficult and said they would initiate LST discussions only with family. LST discussions were actually initiated later than considered appropriate. When medically assessing whether the patient is imminently dying, 56% of doctors experienced disagreements with other doctors, which could affect their decisions. @*Conclusion@#This study found that most doctors experienced serious difficulties regarding communication with patients and family and medical assessment of dying process during LST discussions. To alleviate these difficulties, further institutional support is needed to improve the LST discussion between doctors, patients, and family.
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Objective@#We investigated the prevalence and associated factors of insomnia disorder among survivors of coronavirus disease of 2019 (COVID-19). @*Methods@#This population-based cohort study used data from the National Health Insurance Service COVID-19 cohort database from January 1 to June 4, 2020. COVID-19 patients were defined as individuals whose test confirmed that they were infected, regardless of the severity, and survivors were defined as individuals who recovered from the infection. @*Results@#A total of 299,968 individuals were included in the final analysis, and 6,934 were considered as COVID-19 survivors, while the control group comprised 292,764 individuals. In the multivariable model after covariate adjustment, COVID-19 survivors had a 3.33-fold higher prevalence of insomnia disorder than the control group (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 2.98–3.73; p<0.001). In the sensitivity analysis, the COVID-19 survivors with no specific treatment and the survivors with specific treatment were associated with a 3.16-fold (OR: 3.16, 95% CI: 2.77–3.59; p<0.001) and 3.89-fold (OR: 3.89, 95% CI: 3.17–4.78; p<0.001) higher prevalence of insomnia disorder than the control group. @*Conclusion@#In South Korea, 5.4% of COVID-19 survivors were diagnosed with insomnia disorder at 6 months follow-up. Thus, insomnia disorder is a public health issue for COVID-19 survivors.
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Objective@#While recent studies have found deficits in theory of mind (ToM) skills in individuals at ultra-high risk (UHR) for psychosis, empathic tendencies in these subjects remain unclear. The presence of high schizotypy and compromised executive functions, which are found in UHR individuals, would affect ToM skills and empathic tendencies. We investigated the ToM skills and empathic tendencies of UHR individuals and examined their relationship with schizotypy and executive function. @*Methods@#This study included 28 UHR individuals and 28 age- and sex-matched healthy controls. All participants completed a self-reported empathic scale (Interpersonal Reactivity Index) and the Wisconsin Schizotypy Scales. Additionally, the ToM Picture Stories Task and Wisconsin Card Sorting Test were conducted. @*Results@#UHR individuals showed a trend toward lower self-reported empathic tendencies; however, there were no differences in ToM skills between the two groups. Of the four subscales of the IRI, only empathic concern showed a significant difference between the two groups. Empathic concern was inversely associated with negative schizotypy. @*Conclusion@#Our findings suggest that UHR individuals show relatively preserved cognitive empathy but compromised emotional empathy. Furthermore, in UHR individuals, the empathic concern subscale of the IRI was associated with negative schizotypy, while ToM skills were related to positive schizotypy and executive function.
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Objective@#Relationship between hair cortisol concentration (HCC) and stress-related psychological measures are inconclusive, possibly due to overlooked heterogeneity regarding childhood trauma and a lack of comprehensive research on stress-related psychological factors. This study aims to compare young adults without history of childhood trauma to young adults who experienced childhood trauma using HCC and various stress-related psychological factors, as well as investigate the impacts of childhood trauma on the association between HCC and stress-related psychological measures. @*Methods@#A total of 206 young, healthy adults were recruited. We divided participants into two groups depending on whether or not they had suffered moderate-to-severe childhood trauma (CT+ and CT-) and compared HCC and various stress-related psychological measures between groups. Using multiple linear regression analyses, we assessed the associations between HCC and stress-related psychological measures for each group. @*Results@#We found no difference between the groups in HCC or the reported number of stressful life events in the past year; however, CT+ individuals reported higher stress perception, more depressive and anxiety-related symptoms, and more difficulties in emotion regulation than CT- individuals. HCC was associated with emotion dysregulation among the CT- individuals, but not among the CT+ individuals. @*Conclusion@#These findings suggest that history of childhood trauma should be considered in studies using HCC as a biomarker for stress in young adults. Furthermore, HCC might be a useful biomarker of stress and stress-related emotion dysregulation in individuals without moderate-to-severe childhood trauma.
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Background@#During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. @*Methods@#From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. @*Results@#Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. @*Conclusion@#Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.
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Purpose@#This study aimed to investigate difficulties doctors experience during life-sustaining treatment (LST) discussion with seriously ill patients and their families after enactment of the LST Decisions Act in February 2018. @*Materials and Methods@#A cross-sectional survey was conducted in a tertiary hospital in the Republic of Korea in August 2019. Six hundred eighty-six doctors who care for seriously ill patients were given a structured questionnaire, and difficulties during the discussion were examined. @*Results@#One hundred thirty-two doctors completed the questionnaire. Eighty-five percent answered they treat cancer patients. Most (86.4%) experienced considerable difficulties during LST discussions (mean score, 7.4±1.6/10). The two most common difficulties were communication with patients and family and determining when to discuss LST. Two-thirds of doctors found direct discussions with the patient difficult and said they would initiate LST discussions only with family. LST discussions were actually initiated later than considered appropriate. When medically assessing whether the patient is imminently dying, 56% of doctors experienced disagreements with other doctors, which could affect their decisions. @*Conclusion@#This study found that most doctors experienced serious difficulties regarding communication with patients and family and medical assessment of dying process during LST discussions. To alleviate these difficulties, further institutional support is needed to improve the LST discussion between doctors, patients, and family.