• Journal of Hospice and Palliative Care
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• v.15 no.2
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• pp.77-87
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• 2012

Purpose: This study investigated the effects that music therapy by self-selected music listening has on the affect and stress relief in adult patients who have been diagnosed with terminal cancer by pain level. Methods: Participants were 20 terminally ill cancer patients who were over 18 years old and were admitted to the hospice and palliative care unit of a local hospital. At the beginning of each session, participants selected music of their choice. Each participant had a total of six 30-minute music listening sessions. Participants were grouped into two according to their self-rated perceived pain scores on the visual analogue scale and numeric rated score: 5 and above and less than 5. Each participant completed a questionnaire on their affect state before and after each session and a questionnaire on their stress level before the first session and after the last session. Further analysis was performed to compare differences between the two groups according to pain level. Results: There were significant differences in patients' affect before and after each session (P<0.001) and stress level before and after the therapy (P=0.001). Conclusion: In this study, self-selected music listening had positive effects on terminal cancer patients' affect and stress regardless of perceived pain level. Therefore, self-selected music listening can be used as an appropriate intervention to improve affect and reduce stress in terminal cancer patients in the hospice and palliative care unit.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.232-237
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• 2004

Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

• Journal of Hospice and Palliative Care
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• v.15 no.1
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• pp.30-35
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• 2012

Purposes: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. Methods: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. Results: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. Conclusion: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.

• Journal of Hospice and Palliative Care
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• v.17 no.1
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• pp.18-26
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• 2014

Purpose: Anorexia is a common symptom in terminal cancer patients. Some data have suggested a role of visfatin in regulating feeding behavior. We studied the relationship of a serum visfatin level and anorexia in cancer patients provided with hospice care. Methods: After informed consent was obtained, 69 cancer patients over 20 years old at a hospice center were enrolled in the study from July 2009 to July 2010. We characterized patients by age, sex, body mass index, primary cancer site, and Eastern Cooperative Oncology Group (ECOG) performance status, etc. Also, blood tests were performed to measure the level of hemoglobin, white blood cell (WBC), C-reactive protein (CRP), total cholesterol, albumin, lymphocyte count, glucose, blood urea nitrogen (BUN), creatinine, tumor necrosis factor-alpha (TNF-${\alpha}$), interukin-6, leptin and visfatin. Results: The mean age of subjects was 65.5 years old, According to univariate analysis, pulse, ECOG performance scale, opioid use and visfatin level were different between the anorexia and non-anorexic group (P<0.05). The median visfatin level was higher in the anorexia group than the good appetite group (P=0.0323). Serum visfatin concentrations were not related with either body mass index or serum leptin or total cholesterol levels, but it was negatively correlated with serum albumin levels (P=0.0198) and lymphocyte counts (P=0.0013). Conclusion: This study did not identify a novel link between visfatin levels and anorexia in cancer patients at a hospice.

• Journal of Hospice and Palliative Care
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• v.12 no.1
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• pp.5-13
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• 2009

Purpose: This exploratory study was undertaken to analyze the information needs of family members of terminal cancer patients, collected through the telephone counselling service by National Cancer Information Center. Methods: The study included 113 family members of terminal cancer patients who had enrolled at the National Cancer Information Center for the period from June, 2007 through March, 2008 and had agreed to the survey. Results: The subjects (n=113) consisted of grown-up children (n=82) and spouses (n=8) of patients'. Those in their 40's (n=40) and 30's (n=36) accounted for the majority of the sample. The questions raised most were about the information on treatment methods (n=117), management of terminal cancer patients (n=46), terminal cancer patients' life (n=27), deathbed and prediction of remaining life (n=18), hospitalization (n=16), and financial support (n=15). Most of the subjects were satisfied with the telephone counseling services, and 69% of the subjects had come to know about the telephone counseling service via Internet, and 10.6% of them stated that the PR for the service was poor. Conclusion: It is deemed essential for the government to use the mass media for PR of the hospice services, since family members of terminal cancer patients' are less aware of the hospice conducive to enhancement of patients' remaining quality of life, being involued too deeply in their treatment.

• The Journal of Korean Physical Therapy
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• v.3 no.1
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• pp.189-201
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• 1991

Hospice, a concept of care for dying patients, focuses on providing comfort measures rather than aggressively searching for a cure. Hospice addresses symptom control from a wholistic view under the direction of an interdisciplinary team. Physical therapy fits with many of the tenets of hospice, such as the interdisciplinary team, inclusion of the patient and family as the care unit, provision of treatment in various in and out patient settings, and attention to the comfort of the patient. Physical therapy educators must recognize the need for medical ethics, psychosocial and medicolegal issues to be incorporated throughout the curriculum.

• Journal of Hospice and Palliative Care
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• v.19 no.4
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• pp.331-334
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• 2016

Purpose: Advanced cancer may accompany cold sweat as paraneoplastic symptom. Few studies have been performed on the efficacy of non-steroid anti-inflammatory drug (NSAID) in advanced cancer patients who sweated without fever. Methods: To select study participants, medical records were retrospectively reviewed for patients who satisfied the following criteria: 1) incurable, advanced solid cancer; 2) Cold sweating of 4 or higher on the numeric rating scale (NRS) 4; 3) No evidence of infection or hypoglycemia; 4) No newly started opioid or anti-hormonal agents within one month; 5) NSAID prescription for the management of cold sweating and 6) Documented NRS information before and after NSAID administration. Results: A total of 13 patients were selected after excluding four patients due to lack of NRS information or fever. The mean age was 59 years old (range: 50~71), and nine patients (69%) were male. Bile duct cancer was the most common primary tumor followed by pancreatic cancer, gastric cancer and prostate cancer. The mean NRS of cold sweating dropped from baseline 6.5 (min-max: 4~10) to 1.9 at the follow-up assessment (min-max: 0~5). The mean follow-up period was 9.1 days (range: 2~30 days) from NSAID treatment to assessment. Conclusion: NSAID was effective medication for management of sweating without fever in patients with advanced cancer.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.232-241
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• 2013

Purpose: This study was conducted to do preliminary report of differences and similarities between Koreans residing in Korea and Korean Americans residing in America regarding their awareness of end-of-life care, attitudes toward advance care planning, truth telling, and preferred decision-making model. Methods: Two participating groups were selected: a) Koreans residing in Korea, and b) Koreans Americans who had resided in the United States for at least 20 years. 25 Koreans and 23 Korean Americans who were older than 65 years old participated in this study. They were asked via a self-administered questionnaire that contained demographic questions and questions about end-of-life decision making regarding awareness of end-of-life care, attitudes toward advance care planning, truth telling, and preferred decision-making model. A Chi-square was used to measure differences between Koreans' and Korean Americans planning. A P value of less than 0.5 was considered significant. Data analysis was performed using SPSS 18.0. Results: In some aspects of awareness of end of life care, attitudes toward advance care planning, and truth telling, both groups had similar opinions. However, there were significant differences between groups in the necessity of end of life documentation, preferential informing the truth, and preferred decision making model. Conclusion: There were similarities and differences regarding some end of life issues between the Koreans and the Korean Americans.

• 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.5 no.2
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• pp.146-154
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• 2002

Purpose : Death due to cancer has been continuously increasing, therefore cancer is the first in the cause of death now. A national policy for the elevation of medical costs in cancer patients is necessary, therefore, we searched for the medical costs and its related factors in terminal cancer patients for the effective reduction of the medical costs. Methods : We reviewed the medical records of 259 hospitalized terminal cancer patients who had died during the period of July 1, 2000 to June 30, 2002. History of cancer included type of cancer, type of past treatment, existence of metastasis. Clinical manifestation was examined and medical costs on last admission was categorized based on the account of charges of the department of patient affair on the last hospitalization. For analysis of factors related with medical costs, ANOVA was used. Results : Of the 259 patients, the number of male was 135 cases (52.1%), and the female, 124 cases (47.9%). The most frequent type of cancer was stomach (21.9%) cancer. Of the clinical manifestation, anorexia (87.6%) was the most frequent manifestation. Total medical costs was 740,628,045won, the mean costs was $285,968{\pm}3,070,272won$. The frequent category of medical costs was injection (32.0%), medical accommodation (27.9%), examination (14.0%), in order. The only factor related with mean medical costs was pain (P<0.05). Conclusion : If unnecessary injection of opioid analgesics is reduced, hospice care at home is activated and excessive examination is reduced In terminal cancer inpatients, it will be possible to reduce the medical costs in terminal cancer patients more effectively.