• Journal of Hospice and Palliative Care
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• v.11 no.2
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• pp.99-105
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• 2008

Purpose: In terminally ill cancer patients, accurate prediction of survival is necessary for clinical and ethical reasons, especially in helping to avoid harm, discomfort and inappropriate therapies and in planning specific care strategies. The aim of the study was to investigate prognostic factor of dying patients. Methods: We enrolled the terminal cancer patients from Kangnam St. Mary's Hospital from 2004 until their death. We observed symptoms shown in dying patients and assess 17 common symptoms shown in terminally ill cancer patients, performance status, pain and analgesic use. Results: Average period from hospitalization to death was 11.7 days. The most important prognostic factor is performance status (KPS), average KPS at enrollment is 48% and at last 48 hours is 25%. Physical symptoms that have significant prognostic importance are poor oral intake, weakness, constipation, decreased Karnofsky performance status, bed sore, edema, jaundice, dry mouth, dyspnea. Dying patients showed markedly decreased systolic blood pressure, cyanosis, drowsiness, abnormal respiration, death rattle frequently at 48 hours before death. Conclusion: If we assess the symptoms more carefully, we can predict the more accurate prognosis. The communication about the prognostic information will influence the personal therapeutic decision and specific care planning.

• Korean Journal of Hospice Care
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• v.1 no.1
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• pp.34-45
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• 2001

To evaluate the effect of informational support by hospice team on family caregivers of terminally ill cancer patients, 22 family caregivers of D University Hospital in Daegu city were participated. The research was conducted from Aug. 16th to Oct. 28th 2000 by using self-reported questionnaires. The instruments used in this study were the Weinert's scale of perceived social support, Spielberger's state anxiety inventory, CES-D, and Ellison and Paloutzian's spiritual well-being scale. The intervention was designed to give educational and counselling program up to 7 times within 4 weeks. Educational and counselling booklets which made by the researcher were used step by step by hospice team. The data were analysed frequency, percentage, Wilcoxon Singed Ranks Test Test with SPSS Win 10.0/PC. The results obtained from this study were as follows: 1.The perceived social support of family caregivers was significantly increased after ready planned informational support was applied by hospice team(z=-3.045, p=0.002). 2.The anxiety of family caregivers was significantly reduced after ready planned informational support was applied by hospice team(z=-3.348, p=0.001). 3.The depression of family caregivers was significantly reduced after ready planned informational support was applied by hospice team(z=-3.641, p=0.000). 4.The spiritual well-being score of family caregivers was not significantly improved after ready planned informational support was applied by hospice team(z=-0.422, p=0.673). In conclusion, the results of this study clearly suggests that the informational support provided by hospice team not only increased the family caregivers' who are caring for terminally ill cancer patients. Therefor the informational support program designed by researcher for family caregivers who are caring for terminally ill cancer patients should be utilized and expended.

• Research in Community and Public Health Nursing
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• v.12 no.1
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• pp.175-186
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• 2001

To evaluate the effect of informational support by hospice team on family caregivers of terminally ill cancer patients. 22 family caregivers of D University Hospital in Daegu city were participated. The research was conducted from Aug. 16th to Oct. 28th 2000 by using self-reported questionnaires. The instruments used in this study were the Weinert's scale of perceived social support. Spielberger's state anxiety inventory. CES-D. and Ellison and Paloutzian's spiritual well-being scale. The intervention was designed to give educational and counselling program up to 7 times within 4 weeks. Educational and counselling booklets which made by the researcher were used step by step by hospice team, he data were analysed frequency. percentage. Wilcoxon Singed Ranks Test with SPSS Win l0.0/PC. The results obtained from this study were as follows; 1. The perceived social support of family caregivers was significantly increased after ready planned informational support was applied by hospice team(z=-3.045. p=0.002). 2. The anxiety of family caregivers was significantly reduced after ready planned informational support was applied by hospice team(z =-3:348. p=0.001). 3. The depression of family caregivers was significantly reduced after ready planned informational support was applied by hospice team(z=-3.641. p=0.000). 4. The spiritual well-being score of family caregivers was not significantly improved after ready planned informational support was applied by hospice team(z=-0.422. p=0.673). In conclusion. the results of this study clearly suggests that the informational support provided by hospice team not only increased the family caregivers' who are caring for terminally ill cancer patients. Therefor the informational support program designed by researcher for family caregivers who are caring for terminally ill cancer patients should be utilized and expended.

• Journal of Hospice and Palliative Care
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• v.5 no.2
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• pp.111-124
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• 2002

Purpose : Although the average life expectancy has increased due to advances in medicine, mortality due to cancer is on an increasing trend. Consequently, the number of terminally ill cancer patients is also on the rise. Predicting the survival period is an important issue in the treatment of terminally ill cancer patients since the choice of treatment would vary significantly by the patents, their families, and physicians according to the expected survival. Therefore, we investigated the prognostic factors for increased mortality risk in terminally ill cancer patients to help treat these patients by predicting the survival period. Methods : We investigated 31 clinical parameters in 157 terminally ill cancer patients admitted to in the Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital between July 1, 2000 and August 31, 2001. We confirmed the patients' survival as of October 31, 2001 based on medical records and personal data. The survival rates and median survival times were estimated by the Kaplan-Meier method and Log-rank test was used to compare the differences between the survival rates according to each clinical parameter. Cox's proportional hazard model was used to determine the most predictive subset from the prognostic factors among many clinical parameters which affect the risk of death. We predicted the mean, median, the first quartile value and third quartile value of the expected lifetimes by Weibull proportional hazard regression model. Results : Out of 157 patients, 79 were male (50.3%). The mean age was $65.1{\pm}13.0$ years in males and was $64.3{\pm}13.7$ years in females. The most prevalent cancer was gastric cancer (36 patients, 22.9%), followed by lung cancer (27, 17.2%), and cervical cancer (20, 12.7%). The survival time decreased with to the following factors; mental change, anorexia, hypotension, poor performance status, leukocytosis, neutrophilia, elevated serum creatinine level, hypoalbuminemia, hyperbilirubinemia, elevated SGPT, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), hyponatremia, and hyperkalemia. Among these factors, poor performance status, neutrophilia, prolonged PT and aPTT were significant prognostic factors of death risk in these patients according to the results of Cox's proportional hazard model. We predicted that the median life expectancy was 3.0 days when all of the above 4 factors were present, $5.7{\sim}8.2$ days when 3 of these 4 factors were present, $11.4{\sim}20.0$ days when 2 of the 4 were present, and $27.9{\sim}40.0$ when 1 of the 4 was present, and 77 days when none of these 4 factors were present. Conclusions : In terminally ill cancer patients, we found that the prognostic factors related to reduced survival time were poor performance status, neutrophilia, prolonged PT and prolonged am. The four prognostic factors enabled the prediction of life expectancy in terminally ill cancer patients.

• Journal of Hospice and Palliative Care
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• v.9 no.2
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• pp.93-100
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• 2006

Purpose: This study was designed to understand the doctor's attitude toward hospice and palliative care for terminal cancer patients. Methods: Specialists who work at general hospital were surveyed with questionnaires about hospice and palliative care for terminal cancer patients. The questionnaires comprise 17 items. The data were statistically analyzed. Results: Eighty one doctors responded. Their median age was 35 years old. Thirty six doctors (44.4%) were from internal medicine. The median of specialist's experience was 4 years. Forty three respondents (53.2%) have rarely examined and treated cancer patients even a week. Thirty seven respondents (45.6%) knew the exact definition of hospice and palliative care. Eighty respondents (98.8%) felt that hospice and palliative care is necessary, and 91.2% of them responded the necessity of palliative medicine specialist. As to the question 'Do you positively referred terminal cancer patient to hospice and palliative care?', 55 respondents (67.9%) responded 'Yes' and 22 (27.2%) 'No'. Among the 'Yes' respondents 17 (30.9%) had an experience of hesitation for referring patients to hospice and palliative care; the most common reason was the disagreement of family members (6, 35.3%). As for the reasons of responding 'No', 6 doctors (27.2%) did so because of their 'feeling of abandoning the patients' and the other f for the 'lack of information on the referral procedure for hospice and palliative care'. Thirty seven specialists (45.7%) thought it is most desirable for the patients to have hospice and palliative care for 3 months before death. Fifty eight specialists (71.6%) responded that hospice and palliative care help controlling the patient's psychological symptoms before all. Conclusion: While most doctors recognize the need of hospice and palliative care for patients with terminal ranter, their attitude toward hospice and palliative care was rather reserved. We suggest that continuing education, information and promotion for hospice and palliative care should be provided for doctors.

• Research in Community and Public Health Nursing
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• v.16 no.3
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• pp.270-281
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• 2005

Purpose: The objective of this study was to understand the caring experience of families with terminal cancer patients. Method: This was designed to be an inductive and descriptive study. Forty-seven families with terminal cancer patients were interviewed in depth and collected data were examined through content analysis. Result: The main categories of difficulties found in this study were 'suffering of patient', 'emotional suffering of family', 'bereavement of patient', 'difficulties in coping', 'problems in treatment', 'incurable situation', 'family problems', 'relationship with other people', 'economic problems', 'spiritual problems', 'problems in the future', 'informing patients of their condition', 'preparing death', 'emotional unstability', 'meaninglessness', 'unkindness of medical teams', 'poor environment for treatment', 'difficulties in hospital environment' and 'economic burden'. Conclusion: The main point found from this result was that families taking care of terminal cancer patients are suffering emotionally from watching the patients' pains and had difficulties in coping with the patients' situation and treatment. In addition, they had negative experiences in medical teams' attitude and hospital environment. This result can be used as an important guide for nurses to assess families' needs in the terminal care setting.

• Korean Journal of Adult Nursing
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• v.18 no.5
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• pp.746-759
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• 2006

Purpose: This study was designed to systematically explore and elicit information about terminally ill cancer patients' and primary family caregivers' subjectivity of death. Method: Using Q-methodology, 21 terminally ill cancer patients and 19 primary family caregivers sorted 40 statements during personal interviews. Results: The results of this study show that terminally ill cancer patients have four factors ('Attachment to life', 'Hope for heaven', 'Resignation to reality', 'Avoidance of pain') of response and primary caregivers have four factors('Dependence on religion', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality'). Comparing the subjectivities of death of terminally ill cancer patients and primary family caregivers, 'Hope for heaven' and 'Dependence on religion' reveal the similarities of their outlook. On the other hand, 'Attachment to life', 'Resignation to reality', 'Avoidance of pain', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality' reveals different aspects of their outlook. The group of terminally ill cancer patients and their families divided into four types. Type A was 'Attachment to life and Agony of reality', type B was 'Attachment to life and Obedience to fate', type C was 'Hope for heaven and Dependence on religion' and type D was 'Resignation to reality and Faithfulness to reality'. The positive group was C or 'Hope for heaven and Dependence on religion'. Conclusion: There are significant differences found in the subjective structure of death among terminally ill cancer patients and primary family caregivers. Therefore, it is necessary to develop an individualized nursing intervention for terminally ill cancer patients and family caregivers.

• The Korean Journal of Rehabilitation Nursing
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• v.17 no.1
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• pp.18-26
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• 2014

Purpose: To improve the family functioning, fear of death and depression among the terminally ill cancer patients, the effects of letter as an independent nursing intervention were identified. Methods: Non-equivalent control group pre and post test design was used. Subjects were 60 patients and their family members who were hospitalized at hospice units of an university-affiliated hospital. Patients and their family members were encouraged to write a letter to each other at least 4 times for 2 weeks. Results: Family functioning, fear of death and depression in the experimental group were significantly more improved after intervention than those of control group, even depression of experimental group before intervention was worse than that of control group. Conclusion: Writing a letter to family members is worth to use as an independent nursing intervention for terminally ill patients. It is recommended that further study to identify the potential of letters as an independent nursing intervention is implemented for various patients.

• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.257-279
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• 2016

Recently, the Well-dying Act was legislated in Korea, and it will come into effect in August 4, 2017. This Act allows to withdraw the life sustaining treatment from impending death patients and also provide the hospice and palliative treatment to terminal patients. In the Supreme Court's case so called "Madam Kim", medical condition of Madam Kim was a persistent vegetative status owing to brain damage and her family members wanted to remove the artificial ventilation. In 2009, the Supreme Court allowed to withdraw the artificial ventilation under the specific conditions. We applied this new Well-dying Act to the Madam Kim's case hypothetically in order to know this Act can reasonably solve the problem of life sustaining treatment for dying or terminal patients. For the impending patients, the Well-dying Act has the problem not to withdraw the futile treatment due to the advance directives of patients. Vice versa, the terminal patients have no chance to withdraw the life sustaining treatment due to the this Act impose the duty to provide the hospice and palliative treatment despite of advance directives. We need to ruke out the persistent vegetative patients from the terminal patients caused by the cancer, acquired immune deficiency syndrome, chronic obstructive lung disease and chronic liver cirrhosis, In addition, we have to discuss the effect of the advance directives of terminal patients in view of self determination right.

• Journal of Hospice and Palliative Care
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• v.21 no.2
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• pp.51-57
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• 2018

Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.