• Journal of Hospice and Palliative Care
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• v.14 no.1
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• pp.34-41
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• 2011

Purpose: The purpose of this study was to analyze the reason to select complementary and alternative therapy for terminally ill cancer patients. Methods: The data were collected from 21 terminal cancer patients and families through the in-depth interview. Data analysis were performed by the Colaizzi's phenomenological method (1976). Results: The reason to select complementary and alternative therapy for terminal cancer patients and families was then categorized with 4 elements; Awareness of limitations in contemporary medical treatments, Belief in effectiveness of the CAM, Satisfaction with emotional needs of family members, and Disbelief due to negative attitudes of physicians. The result indicated the following 9 themes expectation for a complete cure, uncertainty in hospital treatments, complementary method for management of side effect of chemotherapy, alleviation of symptoms and life-sustaining, fear for side effects of cancer treatments, belief in earned information, referrals by other, responsibility of family, and dissatisfaction with negatine attitudes of physicians. Conclusion: Physicians should provide a sufficient explanation and try to effectively communicate with clients about hospice and palliative service and the CAM. We strongly realized that concerns about patients' best care and satisfactions with family's needs should be understood.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.57-65
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• 2014

Purpose: Since most terminally ill cancer patients die of multiple organ failure, plasma endotoxin concentration levels may be used to predict the life expectancy. This study was performed to evaluate the clinical significance of endotoxin level in plasma as a prognostic factor for survival in patients with terminal cancer. Methods: This study was conducted with 56 terminally ill cancer patients, above 20 years old, from April 2009 through October 2009. Demographic characteristics, Karnofsky performance status, and survival time were evaluated. We analyzed blood levels of white blood cell hemoglobin, hematocrit, aspartate aminotransferase, alanine aminotransferase, c-reactive protein, total bilirubin and endotoxin in each patient. Results: We considered following variable for univariate analysis: plasma endotoxin level, sex, age, WBC, hemoglobin, hematocrit, AST, ALT, total bilirubin, CRP and severity of pain. Univariate analysis did not show a significant association between plasma endotoxin level and survival time. However, in a multivariate analysis with factors that were found to be significantly associated with survival sex, WBC count and total bilirubin level in univariate analysis, high levels of plasma endotoxin and short survival time were significantly related. Conclusion: Plasma endotoxin level could be used as a prognostic factor to predict the life expectancy of terminally ill cancer patients.

• Journal of Korean Academy of Nursing
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• v.31 no.2
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• pp.206-220
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• 2001

The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04$\pm$2.21), Time 2 (4.82$\pm$2.58) and Time 3(4.73$\pm$2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p〈0.01) and the opioid use (p〈0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p〈0.05) and the amount of physical care the participants received (p〈0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.75-82
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• 1996

Background: Nerve blocks, including epidural analgesia, can be risky for terminal cancer pain patients in generally poor conditions. We performed this study to evaluate the efficacy of intravenous patient-controlled analgesia(PCA) to treat severe pain of terminally ill cancer patients during the last days of life. Methods: We explained the patient's poor general condition to relatives and received a written consent to administer PCA. The starting dose of opioid for PCA in cancer pain management was based on previous 24-hour dose. Previous 24-hour opioid dose was converted to intramuscular morphine equivalent. The concentration of opioid mixed into Basal Bolus $Infusor^{(R)}$ was controlled to allow for one half of the previous 24-hour equianalgesic dose to infuse continuously. Patients controlled their pain by pushing the PCA module themselves. Patients were observed by pain service team. Some discharged patients were treated at home until death. Results: Forty eight patients received PCA for last two years. The most common reason receiving a PCA was the patient's poor general condition(52.0%). The mean starting dose of PCA was $20.6{\pm}16.2$ mg of morphine. Over eighty percents of the patients were in good or tolerable state of analgesia. Half of the patients expired within one week. The mean duration of PCA was $8.7{\pm}7.0$ days. The problems during PCA were: difficulty in maintaining intravenous routes, early loss of mentality after starting PCA, hypotension and nausea. Conclusion: We concluded that PCA, if correctly, is an effective, relatively safe and readily controllable method of pain management in terminally ill cancer patients during the last days of life. For future considerations, terminal patients may expire at the comfort of their own homes after the resolution of legal problems regarding using opioid in home care.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.93-98
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• 2008

Rare cases of IgG associated mesangial glomerulonephritis(IgG GN) defined by exclusive or predominant mesangial IgG deposits were reported first by Sato et al.(1993). and subsequently 10 pediatric cases were reported by Yoshikawa et al.(1994). Previous reports suggested that the prognosis of IgG GN is relatively benign course but recent report suggested that prognosis of IgG GN is highly variable. Also the recurrence of IgG GN in a renal transplant was reported by Fakhouri et al. (2002). Such a recurrence highlights the specificity of this type of glomerulonephritis. We experienced two pediatric cases of IgG GN proven by renal biopsy. Case 1. 4-year-old girl with nephrotic syndrome admitted because of general edema. The patient's urinalysis showed proteinuria and microscopic hematuria. Renal biopsy was performed because of relapsed nephritic syndrome. Light microscopic finding was nonspecific with almost normal histology. Immunofluorescent findings showed diffuse segmental IgG(+) and IgM(+) deposits in the capillary walls, and focal segmental spotty C4(trace), C1q(trace) deposits. Electron microscopic findings showed focal portion of mesangial electron dense deposits without mesangial widening. Case 2. 11-year-old girl admitted for evaluation of microsopic hematuria detected through mass school urinary screening program. Renal biopsy was performed for exact diagnosis. Immunofluorescent findings showed focal segmental IgG(+), IgM(+/-) and C3(+/-) deposits. Electron microscopic findings showed focal portion of mesangial electron dense deposits without mesangial widening.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.242-252
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• 2013

Purpose: The purpose of this study was to examine medical professionals' perception and knowledge of hospice and palliative care (HPC) and attitude toward death. Methods: The survey was performed on 84 physicians and 172 nurses in Busan, Korea. Data were collected from April 5, 2012 to April 30, 2012. Results: Regarding the purpose of HPC, the most popular perception was "To alleviate pain and accommodate comfort" among both physicians and nurses. For the need for HPC, "Terminal patients need a separate ward for emotional fluctuation" the answer chosen by both groups the most. Both groups scored low on knowledge of HPC. For pain and symptom management, physicians scored higher than nurses (physicians: $6.97{\pm}1.82$, nurses: $5.68{\pm}1.93$, P<0.001). Conclusion: Considering the survey results, we suggest development of a program to improve medical professionals' perception and knowledge of HPC and attitude toward death.

• Korean Journal of Hospice Care
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• v.2 no.2
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• pp.49-57
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• 2002

Background: The purpose of this study is to find out to how much influence religion had on the quality of life in patients admitted to the hospice facility at Saemmul's House. Terminal cancer patients were assessed one to two weeks after admittance to Saemmul's House. Metohd: The subjects of this study were numbered at 75 patients and were admitted to the hospice facility at Sammul's house between January 2002 and July 2002. The data regarding quality of life was collected using a questionnaire prepared by the sammul Hospice and were analyzed by means of ANOVA and T-test. Result: As a result of this study, there was no noticeable difference in quality of physical, psychosocial life between the patients with conviction of salvation and the other patients. However, it shows that the former enjoyed a higher spiritual quality of life than the latter. In case of baptized patients and unbaptized patients, there were no differences in terms of physical and psychosocial quality of life, but the baptized patients demonstrated a higher spiritual quality of life. After admittance, patients were grouped by duration of conviction of salvation I.e., those that believed more than 5 years and those that believed less than 5 years. In terms of physical, psychosocial quality of life, there was little difference between the two groups. However, those who believed more than 5 years demonstrated a higher spiritual quality of life. However, there was no difference in quality of life among patients, regardless of their belief in God, after receiving spiritual care at the hospice. Conclusion: We got a few conclusions in accordance with result gained by this study. First, spiritual support is very important to improving quality of patients' lives in hospices. Second, hospice programs are needed keenly and spiritual support for patients from trained experts is needed 24 hours a day. Third, because trained experts(ministry) are urgently needed to lend spiritual support, hospice courses must be taught at all colleges of theology. Fourth, a hospice program must provide a proper atmosphere that can give spiritual support and therefore all hospices must build such as environment. Fifth, a tool for spiritual support of hospice must be developed.

• Journal of Korean Academy of Nursing
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• v.24 no.2
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• pp.190-205
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• 1994

Respect for human life and respect for human dignity are two basic values to which organized nursing has urged its members to adhere in their service to mankind. Thus it is the nurses’ duty to provide health care in support of sustenance of life and to pay respect for the patient’s right to dignity. In practice, however, nurses may experience dilemmas between these duties much due to the de velopment of modern advanced techniques. These dilemmas have become more complex and difficult to resolve. Nurses are often faced with situations in which the terminally ill refuse professional care, posing serious conflicts between respect for human life and respect for human rights to self-determination. In such cases, resolution of the problem is not a simple matter, thus requires intensive study into the ethical questions related to the situation. The purpose of this study was to identify ethical problems that nurses experience in caring for terminally ill patients and explore the ways to the resolution of problems within the context of the situations. The methodology used for the study was a case study method which ‘New Casuistry’ proposed by Jonsen & Toulmin(1988) and the ‘Specified Principlism’ proposed by Degrazia(1992) as an alternative to old deductive and intuitive method. Cases were developed through semistructured indepth interviews according to the casutistry method. A total of seven nurses were interviewd who were caring for therminally ill patients. Four cases out of a total 14 cases were related to the topic. Through the case analysis it became evident that nurses appreciated other values more often than respect for the patient’s right to self-determination. These other values were convenience and efficiency in nursing practice in case 1, preservation of life above all other values in case 2, provision of nursing care to fulfill the nurse’s professional obligation at most in case 3, and respect for the family’s demand against the patient’s wish in case 4. This study showed that the most important ethical problems were conflict between respect for the patient’s right to self-determination and sustenance of life for the fulfillment of professional obligation. For this problem, benefit /burden analysis from the perspective of the patient and family for the promotion of patient’s wellbeing may be a way to resolve the conflict. Further, through these analysis it was shown that physicians’ and families’ opinions dominated in the decision - making and the opinions of nurses’ and patients’ tended not to be reflected. Thus the patient's right to his or her care was not readily respected. To solve this problem. nurses should make efforts to communicate reciprocally with their patients, family members and physicians in an effort to respect for their patient’s rights to life and diginity from the point of view and values of the patient. It is also important that nurses provide good basic nursing care up to the time of death regardless of decisions about providing or not aggressive treat-ment for chronically and terminally ill patients.

• Journal of Korean Academy of Nursing
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• v.21 no.3
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• pp.418-435
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• 1991

The purposes of this study were to find out the effects of hospice care for the quality of life of the terminally - ill patients and to analyze the relationship between the effect of hospice care and the general characteristics of subjects. The subjects of the study were 32 terminally - ill patients hospitalized in the two general hospitals in Seoul, which have the hospice care unit. The data were collected using the questionnaire with interviews. They were done from Sept.28, 1989 to March 20, 1991. The tools used for the research were 17-item questionnaire regarding general characteristics, 42-item questionnaire about the quality of life (11- item for physical, 16 for psychosocial, and 15 for spiritual). The questionnaires were to measure the duality of life by means of the measure instruments of Betty R. Farewell(1989), Stein Kaasa(1988), Palm Pamela(1987), and Hwa-sook Choi(1987). 42 items were used after pre-test. In accordance with each purpose in this study, frequency and percentage were used on the general characteristics of subjects. ANOVA, t-test, and Pearson correlation were employed to evaluate the general characteristics of subjects and different level of quality of life before-and-after hospice care. The results of the study may be summarized as follws : 1. The effects of hospice care. Main Hypothesis : “The quality of life of the terminally - ill patients will be different from before-and-after hospice care” was supported(t＝6.82, df＝31, p＝ .000). Sub Hypothesis 1 : “The quality of life of the terminally - ill patients in the physical aspects will be different from before - and -after hospice care” was not supported(t＝0.07, df＝31, p＝ .946). Sub Hypothesis 2 : “The quality of life of the terminally - ill patients in the psychosocial aspects will be different from before-and-after hospice care” was supported (t＝4.69, df＝31, p＝ .000). Sub Hypothesis 3 : “The quality of life of the terminally - ill patients in the spiritual aspects will be different from before-and-after hospice care” was supported(t＝6.64, df＝31, p＝ .000). 2. Relationship between the general characteristics of subjects and the effects of hospice care. (1) The more the number of family, the higher the quality of life in the psychosocial aspects. (2) The higher the age of the patient, the lower the quality of life in the psychosocial aspects. (3) The high educational level of patients enjoy the high quality of life in general. (4) The high religious level of petients enjoy the higy Quality of life in the spiritual aspects. As a results of analysis above : 1. The most effective aspects of the hospice care to the terminally- ill patients was spiritual aspects. The next effective aspects was psychosocial area. 2. The least effective aspcets of the hospice care to the terminally- ill patients was physical aspects. Further study is needed to improve the quality of life in the physical aspects.

• Korean Journal of Hospice Care
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• v.5 no.2
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• pp.75-85
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• 2005

The objective of this research is to provide the basic material for effective hospice care by analyzing the recognition of families who have terminally ill patients over death. To do so, this research is designed to investigate the general tendency toward death and changes after hospice care. To analyse the initial status of the recognition about the death, questionnaires were provided to the families of the terminally ill patients who were taken hospice care from June 1st, 2005 to September 10th, 2005 at Saemmul Hospice. The same questionnaires were distributed to research some changes of the recognition of the death after 3 weeks. As the Data Analysis Methodology, SPSS v.10.0 statistics program were utilized. The summary of this research is as follows. First, by gender, it is analyzed that women have more fear than men in terms of incompetence sense after death. By religion, Christians have less fear than other religious people in terms of fear toward after death and general sense of death. Second, those who experienced deaths of close family members, relatives, friends for the past 3 years have more fear toward the moment of death than those who did not experience it. Third, statistically valid difference was found in terms of fear toward the moment of death, fear toward incompetence, fear toward after death, and fear toward death before and after the hospice care was taken. Based on the result of this research, terminally ill patients' families facing death have shown significant differences on fear and incompetence before and after hospice care was offered. It is necessary that the hospice care should be settled more professionally by expanding the opportunities of hospice care and institutionalizing the system. In addition, hospice activities which are focused on providing hope after death and facing death with dignity and peace should be expanded increasingly as the family members who experienced deaths showed higher degree of fear and powerlessness and Christians have less fear toward death with the help of biblical influence. It is also required that hospice care specialized in recognizing the importance of terminal cancer patients and their families at the same time.