Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Utilization of End-of-Life Care Rooms by Patients Who Died in a Single Hospice Unit at a National University Hospital in South Korea

  • Gyu Lee Kim (Department of Family Medicine, Pusan National University Hospital) ;
  • Seung Hun Lee (Department of Family Medicine, Pusan National University Hospital) ;
  • Yun Jin Kim (Department of Family Medicine, Pusan National University Hospital) ;
  • Jeong Gyu Lee (Department of Family Medicine, Pusan National University Hospital) ;
  • Yu Hyeon Yi (Department of Family Medicine, Pusan National University Hospital) ;
  • Young Jin Tak (Department of Family Medicine, Pusan National University Hospital) ;
  • Young Jin Ra (Department of Family Medicine, Pusan National University Hospital) ;
  • Sang Yeoup Lee (Department of Medical Education, Pusan National University School of Medicine) ;
  • Young Hye Cho (Department of Family Medicine, Pusan National University School of Medicine) ;
  • Eun Ju Park (Department of Family Medicine, Pusan National University Yangsan Hospital) ;
  • Young In Lee (Department of Family Medicine, Pusan National University Yangsan Hospital) ;
  • Jung In Choi (Department of Family Medicine, Pusan National University Yangsan Hospital) ;
  • Sae Rom Lee (Department of Family Medicine, Pusan National University Yangsan Hospital) ;
  • Ryuk Jun Kwon (Department of Family Medicine, Pusan National University Yangsan Hospital) ;
  • Soo Min Son (Department of Family Medicine, Pusan National University Yangsan Hospital)
  • Received : 2023.02.13
  • Accepted : 2023.04.26
  • Published : 2023.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: For the dignity of patients nearing the end of their lives, it is essential to provide end-of-life (EoL) care in a separate, dedicated space. This study investigated the utilization of specialized rooms for dying patients within a hospice unit. Methods: This retrospective study examined patients who died in a single hospice unit between January 1, 2017, and December 31, 2021. Utilizing medical records, we analyzed the circumstances surrounding death, the employment of specialized rooms for terminally ill patients, and the characteristics of those who received EoL care in a shared room. Results: During the 1,825-day survey period, deaths occurred on 632 days, and 799 patients died. Of these patients, 496 (62.1%) received EoL care in a dedicated room. The average duration of using this dedicated space was 1.08 days. Meanwhile, 188 patients (23.5%) died in a shared room. Logistic regression analysis revealed that a longer stay in the hospice unit was associated with a lower risk of receiving EoL care in a shared room (odds ratio [OR]=0.98, 95% confidence interval [CI] 0.97~0.99; P=0.002). Furthermore, a higher number of deaths on the day a patient died was associated with a greater risk of receiving EoL care in a shared room (OR=1.66, 95% CI 1.33~2.08; P<0.001). Conclusion: To ensure that more patients receive EoL care for an adequate duration in a private setting, additional research is necessary to increase the number of dedicated rooms and incorporate them into the hospice unit at an early stage.

Keywords

Acknowledgement

This work was supported by 2022 Research Grant of Pusan National University Hospital.

References

  1. Statistics Korea. Causes of death statistics in 2020 [Internet]. Daejeon: Statistics Korea; 2021 [cited 2023 Mar 12]. Available from: https:// kostat.go.kr/board.es?mid=a20108010000&bid=11773&act=view&list_no=414516&tag=&nPage=1&ref_bid=11742,11743,11744,117 45,11746,11747,11748,11749,11773,11774,11750&keyField=&keyWord=cause. 
  2. Dasch B, Blum K, Gude P, Bausewein C. Place of death: trends over the course of a decade: A population-based study of death certificates from the years 2001 and 2011. Dtsch Arztebl Int 2015;112:496-504.  https://doi.org/10.3238/arztebl.2015.0496
  3. Rabow MW, Hardie GE, Fair JM, McPhee SJ. End-of-life care content in 50 textbooks from multiple specialties. JAMA 2000;283:771-8.  https://doi.org/10.1001/jama.283.6.771
  4. Gomes B, Higginson IJ, Calanzani N, Cohen J, Deliens L, Daveson BA, et al. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol 2012;23:2006-15.  https://doi.org/10.1093/annonc/mdr602
  5. Yun YH, Rhee YS, Nam SY, Chae YM, Heo DS, Lee SW, et al. Public attitudes toward dying with dignity and hospice palliative care. J Hospice Palliat Care 2004;7:17-28. 
  6. Statistics Korea. Preliminary results of birth and death statistics in 2021 [Internet]. Daejeon: Statistics Korea; 2022 [cited 2022 Jul 4]. Available from: https://kostat.go.kr/board.es?mid=a10301010000&&bid=204&act=view&list_no=416897. 
  7. Attia AK, Abd-Elaziz WW, Kandeel NA. Critical care nurses' perception of barriers and supportive behaviors in end-of-life care. Am J Hosp Palliat Care 2013;30:297-304.  https://doi.org/10.1177/1049909112450067
  8. van de Glind I, van Dulmen S, Goossensen A. Physician-patient communication in single-bedded versus four-bedded hospital rooms. Patient Educ Couns 2008;73:215-9.  https://doi.org/10.1016/j.pec.2008.07.004
  9. Tatum PE. End-of-life care: Hospice care. FP Essent 2020;498:26-31. 
  10. Ministry of Health and Welfare. Hospice palliative care 2021 [Internet]. Sejong: MOHW; 2021 [cited 2023 Jan 11]. Available from: http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=363986. 
  11. Ministry of Health and Welfare. Notice No. 2020-187 of the Ministry of Health and Welfare 2020 [Internet]. Sejong: MOHW; 2020 [cited 2023 May 15]. Available from: http://www.mohw.go.kr/react/jb/sjb0406vw.jsp?PAR_MENU_ID=03&MENU_ID=030406&page=1&CONT_ SEQ=359212. 
  12. Otani H, Morita T, Igarashi N, Shima Y, Miyashita M. Private or shared room? A nationwide questionnaire survey on bereaved family members' perceptions of where patients spend their last days. BMJ Open 2022;12:e055942. 
  13. Slatyer S, Pienaar C, Williams AM, Proctor K, Hewitt L. Finding privacy from a public death: a qualitative exploration of how a dedicated space for end-of-life care in an acute hospital impacts on dying patients and their families. J Clin Nurs 2015;24:2164-74.  https://doi.org/10.1111/jocn.12845
  14. Lee SM, Kim SJ, Choi YS, Heo DS, Baik S, Choi BM, et al. Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment. J Korean Med Assoc 2018;61:509-21  https://doi.org/10.5124/jkma.2018.61.8.509
  15. National Clinical Guideline Centre for Acute and Chronic Conditions (Great Britain); Royal College of Physicians of London; Royal College of Surgeons of England; Royal College of General. Care of dying adults in the last days of life. London; National Institute for Health and Care Excellence; 2015. 
  16. Bussmann S, Muders P, Zahrt-Omar CA, Escobar PL, Claus M, Schildmann J, et al. Improving end-of-life care in hospitals: a qualitative analysis of bereaved families' experiences and suggestions. Am J Hosp Palliat Care 2015;32:44-51.  https://doi.org/10.1177/1049909113512718
  17. White N, Harries P, Harris AJ, Vickerstaff V, Lodge P, McGowan C, et al. How do palliative care doctors recognise imminently dying patients? A judgement analysis. BMJ Open 2018;8:e024996. 
  18. Hui D, Kilgore K, Nguyen L, Hall S, Fajardo J, Cox-Miller TP, et al. The accuracy of probabilistic versus temporal clinician prediction of survival for patients with advanced cancer: a preliminary report. Oncologist 2011;16:1642-8.  https://doi.org/10.1634/theoncologist.2011-0173
  19. Gwilliam B, Keeley V, Todd C, Roberts C, Gittins M, Kelly L, et al. Prognosticating in patients with advanced cancer - observational study comparing the accuracy of clinicians' and patients' estimates of survival. Ann Oncol 2013;24:482-8.  https://doi.org/10.1093/annonc/mds341
  20. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 2005;23:6240-8.  https://doi.org/10.1200/JCO.2005.06.866
  21. Chen PY, Huang CH, Peng JK, Yeh SY, Hung SH. Prediction accuracy between terminally ill patients' survival length and the estimations made from different medical staff, a prospective cohort study. Am J Hosp Palliat Care 2023;40:440-6.  https://doi.org/10.1177/10499091221108507
  22. Travers A, Taylor V. What are the barriers to initiating end-of-life conversations with patients in the last year of life? Int J Palliat Nurs 2016;22:454-62.  https://doi.org/10.12968/ijpn.2016.22.9.454
  23. Laryionava K, Winkler EC. Dealing with family conflicts in decision-making ine-of-life care of advanced cancer patients. Curr Oncol Rep 2021;23:124. 
  24. Walczak A, Henselmans I, Tattersall MH, Clayton JM, Davidson PM, Young J, et al. A qualitative analysis of responses to a question prompt list and prognosis and end-of-life care discussion prompts delivered in a communication support program. Psychooncology 2015;24:287- 93.  https://doi.org/10.1002/pon.3635
  25. Oh JY, Lee DH, Im JW, Shin YJ, Park DH, Yoo HL, et al. Hospice and palliative care services system improvement plan [Internet]. Wonju: Health Insurance Review & Assessment Service; 2020 [cited 2023 Mar 10]. Available from: https://repository.hira.or.kr/handle/2019.oak/2259.