• Journal of Hospice and Palliative Care
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• 제27권3호
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• pp.103-106
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• 2024

Palliative care is a comprehensive approach aimed at improving the quality of life for patients and their families. The symptom burden and care needs of patients with end-stage, non-malignant diseases are similar to those experienced by patients with advanced cancer. Therefore, the World Health Organization (WHO) has recommended the expansion of palliative care to encompass a broad spectrum of diseases. However, in Korea, the adoption of palliative care for non-malignant conditions remains markedly low, presenting numerous challenges that differ from those associated with cancer. Key barriers to implementing hospice care for non-malignant diseases include the difficulty in predicting end-of-life and a general lack of awareness about hospice palliative care among healthcare providers, patients, and their families. Additionally, there is a risk that suggesting palliative care to patients with non-malignant diseases might be misinterpreted as an endorsement by healthcare providers to cease treatment or abandon the patient. This article explores strategies to broaden the scope of hospice and palliative care for patients with non-malignant diseases.

• Journal of Hospice and Palliative Care
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• 제22권4호
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• pp.166-173
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• 2019

목적: 높은 수준의 호스피스 및 완화의료 교육은 한국 의과대학 교육과정에 필요하다. 하지만 이와 연관된 연구는 많지 않은 실정이며 이에 본 연구는 호스피스와 완화의료 교육 과정을 마친 의과 대학생의 호스피스와 완화의료에 대한 인지 및 태도 변화를 연구하기 위해 수행 되었다. 또한 의과대학의 기본 교육 과정 안에서 호스피스 교육과정의 역할에 대해서도 탐구하고자 한다. 방법: 호스피스와 완화의학에 대한 통합적인 교육과정을 마친 총 76명의 의학과 4학년 학생이 자기 기입 형태의 설문조사에 참여 하였다. 교육 과정을 마친 후 수업 전과 비교하여 수업 후의 후의 호스피스 및 완화의료에 대한 지식과 태도를 조사하였다. 결과: 교육 과정을 이수한 이후 가장 큰 변화는 호스피스 및 완화의료 세팅에서 적절한 마약성 진통제를 사용할 수 있는가 하는 부분에서 나타났다(3.50점 vs 5.32 점; P≤0.001). 수업 전과 비교하여 수업 이후 호스피스와 완화의료에 대한 태도를 나타내는 질문인 "나는 호스피스와 완화의료의 목표와 역할을 바르게 알고 있다"고 답한 학생은 17명(22.4%)에서 65명(85.6%)으로 증가하였다. 또한 "예비의사로서 나는 호스피스와 완화의료의 바른 적용 시점을 알고 있다"고 답한 학생은 수업 전의 22명(28.9%)과 비교하여 65명(85.6%)으로 증가하였다. 결론: 통합적인 호스피스 완화의료 교육과정은 의과 대학생의 호스피스 및 완화의료에 대한 인식과 태도를 긍정적인 방향으로 변화시킬 수 있다.

• Journal of Hospice and Palliative Care
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• 제24권1호
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• pp.1-12
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• 2021

Hospice palliative care refers to holistic care provided by an interdisciplinary team aimed at improving the quality of life of patients suffering from life-threatening diseases and their families. Among interdisciplinary team members, hospice advanced practice nurses (APNs) trained as master's-level advanced nursing professionals are leaders who play an important role in providing patient-centered care and improving the quality of services. The Medical Service Act revised in 2018 requires the scope of practice of APNs in each field to be specified in the Ordinance of the Ministry of Health and Welfare. Accordingly, discussions on the role and scope of practice of hospice APNs are actively underway. In this review, the curriculum of hospice APNs, their work responsibilities and roles, and their current status are reviewed, and the future direction of the hospice APN system is also discussed.

• Journal of Hospice and Palliative Care
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• 제25권2호
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• pp.76-84
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• 2022

Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

• Journal of Hospice and Palliative Care
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• 제13권2호
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• pp.69-75
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• 2010

Hospice is defined by the National Hospice and Palliative Care Organization (NHPCO, USA) and WHO, as a program of care that provides comprehensive medical, nursing and support services to dying patients and their family. Despite its broad definition, however, hospice care in Korea has been focused mostly on terminal cancer patients. Thus hospice eligibility for patients with advanced cancer is relatively easier to predict than those with other fatal chronic illnesses such as heart, lung, renal or liver diseases, and dementia. This makes it more difficult for patients and families to prepare for death and gain full benefits of hospice care. This article introduces the medical guidelines for selected non-cancer patients who are expected to live for only six months, this making it possible for patients, who are nearing the end of life, to avoid unwarranted suffering.

• 보건의료산업학회지
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• 제12권4호
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• pp.173-190
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• 2018

Objectives: This study was conducted to analyze the symptoms and care needs of home-based hospice palliative patients in Busan and to provide a basic reference for developing practical guidelines for their care. Methods: By examining the registration cards of 409 hospice palliative patients, who were registered in community health centers in Busan as of 2016, this study retrospectively analyzed their characteristics, symptoms and care needs. Results: The average age was 70.6 years, 59.4% were receiving medical benefits, and 48.4% lived alone. As per the data obtained from the Palliative Performance Scale, many were able to mobile. Fatigue was the most severe and depression and anxiety were reported together, and their care needs were also high. Most subjects reported mild or low pain, but care needs were high. Furthermore, the medical benefits group showed a high level of symptoms and care needs across areas. Conclusions: To help subjects to live in their homes for as long as possible, it is necessary to identify symptoms and care needs and provide services in accordance with their severity and situation. Thus, it is necessary to develop practical guidelines for standardized community hospice palliative care services.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.22-25
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• 2023

Although most patients prefer dying at home, patients whose condition rapidly becomes critical need care in the intensive care unit (ICU), and it is rare for them to die at home with their families. Therefore, interest in hospice and palliative care for patients in the ICU is increasing. Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU: patients with chronic critical illnesses who need tracheostomy, percutaneous gastrostomy tube, and extracorporeal life support; patients aged 80 years or older; stage 4 cancer patients; patients with specific acute diseases with a poor prognosis (e.g., anoxic brain injury and intracerebral hemorrhage requiring mechanical ventilation); and patients for whom the attending physician expects a poor prognosis. There are two PC models-a consultative model and an integrative model-in the ICU setting. Since these two models have advantages and disadvantages, it is necessary to apply the model that best fits each hospital's circumstances. Furthermore, interdisciplinary decision-making between the ICU care team and PC specialists should be strengthened to increase the provision of hospice and palliative care services for patients expected to have poor outcomes and their families.

• Journal of Hospice and Palliative Care
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• 제22권2호
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• pp.49-66
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• 2019

의료기술 발달 및 경제개발 수준 상승 등으로 호스피스 완화의료(hospice & palliative care) 서비스를 받는 말기 환자들이 점점 늘어나고 있다. 이와 더불어 최근 호스피스 완화의료 분야 임상전문가들은 환자나 가족 대상 호스피스 완화의료 서비스의 질을 향상시킬 목적으로 하는 연구에도 많은 관심을 보이고 있다. 한편 정부의 연구대상자 보호 정책이 강화되면서 IRB(생명윤리심의위원회)에서도 호스피스 완화의료 연구의 연구계획서를 심의할 때 환자의 취약성과 관련된 다양한 윤리적 사안들을 더 엄밀하게 점검하고 있다. 그러나 말기 환자들의 삶의 질 향상 및 유지를 위해서는 질적으로 보장된 호스피스 완화의료 서비스가 제공되어야 한다. 이를 위해서 윤리적으로 안전한 호스피스 완화의료 연구의 시도가 지지되어야 한다. 이에 필자는 호스피스 완화의료 연구의 윤리지침을 종설 논문 형식으로 제안했다. 이는 윤리적으로 안전하고 과학적으로 가치가 있는 연구계획서를 준비해야 하는 연구자 및 그 연구계획서를 심의하는 IRB가 적절하게 참조할 수 있도록 해주기 위함이다.

• Journal of Hospice and Palliative Care
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• 제26권4호
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• pp.149-159
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• 2023

The Spiritual Care Guide in HospiceㆍPalliative Care is evidence-based and focuses on the universal and integral aspects of human spirituality-such as meaning and purpose, interconnectedness, and transcendence-which go beyond any specific religion. This guide was crafted to improve the spiritual well-being of adult patients aged 19 and older, as well as their families, who are receiving end-of-life care. The provision of spiritual care in hospice and palliative settings aims to assist patients and their families in finding life's meaning and purpose, restoring love and relationships, and helping them come to terms with death while maintaining hope. It is recommended that spiritual needs and the interventions provided are periodically reassessed and evaluated, with the findings recorded. Additionally, hospice and palliative care teams are encouraged to pursue ongoing education and training in spiritual care. Although challenges exist in universally applying this guide across all hospice and palliative care organizations in Korea-due to varying resources and the specific environments of medical institutions-it is significant that the Korean Society for Hospice and Palliative Care has introduced a spiritual care guide poised to enhance the spiritual well-being and quality of care for hospice and palliative care patients.

• 성인간호학회지
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• 제15권4호
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• pp.585-595
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• 2003

Purpose: The purpose of this study was to suggest the projected manpower of hospice and palliative care nurses & APNs(advanced practice nurses)needed in the future. Method: Need model, ratio model and expert opinion were used for projecting the number of hospice and palliative care nurses & APNs. Result: 1. The number of Korean hospice facilities was 64 in 2002. The number of hospice nurses in 2001 was 194 and that of beds was 407. 2. The number of hospice target patients was estimated at a minimum of 16,415 to a maximum of 25,254 in 2002, 12,366 to 26,389 in 2005, and 14,057 to 30,000 in 2020. 3. The number of hospice and palliative nurses needed to meet the demands in 2002, 2005 and 2020 was estimated at a minimum of 1,136 to maximum of 1,748, 1,187 to 1,826, and 1,349 to 2,076, respectively. 4. The number of hospice & palliative care APNs needed to meet the demands in 2002, 2005 and 2020 was estimated at 232, 242, and 274, respectively. Conclusion: The legalization of hospice is expected to increase demands for hospice nurses and advanced practice hospice and palliative care nurses in the future.