{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:09:30Z","timestamp":1790197770088,"version":"4.1.0"},"reference-count":34,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Infodemiology"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Public discourse plays an important role in shaping how end-of-life care and medical decision-making are understood within society. In South Korea, the implementation of the Life-Sustaining Treatment Decision Act in 2018 established a legal framework for withholding or withdrawing life-sustaining treatment for patients at the end of life. However, relatively little is known about how public discourse surrounding life-sustaining treatment has evolved over time, particularly before and after the act\u2019s implementation.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to examine how online discourse related to life-sustaining treatment in South Korea evolved using large-scale social media data by identifying dominant themes, tracing their temporal changes from 2014 to 2025, and assessing shifts in sentiment before and after the act.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 16,191 text documents, comprising posts from Naver blogs, Naver cafes, and comments from YouTube, were collected using keywords related to life-sustaining treatment and end-of-life decision-making. Text was preprocessed using the Kiwi tokenizer for Korean morphological analysis, and latent Dirichlet allocation topic modeling was applied to extract underlying themes. A 6-topic solution was selected based on topic coherence and interpretability. Temporal changes in topic prevalence were examined across the study period, and topic distributions were compared between the prelaw (2014\u20102017) and postlaw (2018\u20102025) periods. Sentiment analysis was conducted using the Kunsan National University Korean sentiment lexicon to classify documents into positive, neutral, and negative categories. A study-defined descriptive net sentiment change index was calculated to summarize changes in positive and negative sentiment following policy implementation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Six major themes were identified: death with dignity, hospice and palliative care, aging and social care, end-of-life decision-making, euthanasia debate, and withdrawal of treatment. Discourse volume increased more than 17-fold over the study period. Prior to 2018, discussions were dominated by end-of-life decision-making (255\/573, 44.5%) and withdrawal of treatment (178\/573, 31.1%). Around the time of policy implementation, ethical and legal debates became more prominent. In subsequent years, discourse increasingly reflected care-oriented perspectives, including hospice and palliative care and aging and social care. Sentiment improved most markedly for end-of-life decision-making and hospice and palliative care following the act, whereas aging and social care showed minimal change, and death with dignity exhibited a decline in net sentiment.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Public discourse on life-sustaining treatment in South Korea evolved from a clinical focus to ethical debate and, more recently, to care-oriented perspectives. These changes were temporally associated with the implementation period of the Life-Sustaining Treatment Decision Act but should not be interpreted as causal effects of the legislation. The findings highlight the value of social media data for monitoring policy-associated changes in public discourse on end-of-life care.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/95918","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:51:36Z","timestamp":1790196696000},"page":"e95918-e95918","source":"Crossref","is-referenced-by-count":0,"title":["Shifting Public Discourse on Life-Sustaining Treatment in South Korea From 2014 to 2025: Longitudinal Social Media Analysis"],"prefix":"10.2196","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9844-9145","authenticated-orcid":false,"given":"Miryoung","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3445-6607","authenticated-orcid":false,"given":"Hae Sun","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1177\/0269216317734435","article-title":"What is the impact of population ageing on the future provision of end-of-life care? 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