• Journal of Hospice and Palliative Care
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• 제24권2호
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• pp.130-134
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• 2021

In the era of coronavirus disease 2019 (COVID-19), social distancing and strict visitation policies at hospitals have made it difficult for medical staff to provide high-quality end-of-life (EOL) care to dying patients and their families. There are various issues related to EOL care, including psychological problems of patients and their families, difficulties in EOL decision-making, the complicated grief of the bereaved family, moral distress, and exhaustion of medical staff. In relation to these issues, we aimed to discuss practical considerations in providing high-quality EOL care in the COVID-19 pandemic. First, medical staff should discuss advance care planning as early as possible and use the parallel planning strategy. Second, medical staff should play a role in facilitating patient-family communication. Third, medical staff should actively and proactively evaluate and alleviate dying patients' symptoms using non-verbal communication. Lastly, medical staff should provide care for family members of the dying patient, who may be particularly vulnerable to post-bereavement problems in the COVID-19 era. Establishing a system of screening high-risk individuals for complicated grief and connecting them to bereavement support services might be considered. Despite the challenging and limited environment, providing EOL care is essential for patients to die with dignity in peace and for the remaining family to return to life after the loved one's death. Efforts considering the practical issues faced by all medical staff and healthcare institutions caring for dying patients should be made.

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.252-255
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• 2020

This article aims to discuss the barriers hindering cancer patients from receiving early palliative care, which has been demonstrated to be more effective in improving quality of life and controlling symptoms. Specifically, there are barriers in four aspects of delivering early palliative care. First, the difficulty of starting discussions about early palliative care and the lack of adequate appointment time can impede communication between oncologists and patients and their family members. Second, determining the timing of referral and deciding upon and applying a standard for referral can be barriers in the process of referral from oncology to palliative care. Third, palliative care patients and their family members can face difficulties regarding in what format and by whom the services will be delivered. Fourth, biases, misinformation, and inaccurate beliefs can be barriers in the process of patients and their family members accepting care. In order to facilitate early palliative care, research and policy regarding these barriers are necessary, along with efforts made by medical staff.

• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.51-59
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• 2023

Purpose: We evaluated the status of patients enrolled in South Korea's pediatric palliative care pilot project based on the experience of a single center. This study examined factors related to end-of-life services and differences in medical costs. Methods: The medical records of 120 patients referred by a pediatric palliative care team were analyzed retrospectively. Data from July 1 to February 28, 2022 were collected and analyzed using the chi-square test and the Mann-Whitney U test. Results: Volunteer programs and psychological support (100%), family support and education (99.2%), and financial support through institutional linkage (62.5%) were provided to the participants. In the deceased group, there were no significant differences in general characteristics, which included age, gender, primary disease, religion, duration of hospitalization in an intensive care unit (ICU) and non-intensive care unit (non-ICU). However, the ICU group had fewer opportunities to access individual pain and physical symptom management than the non-ICU group and there were limitations in linking with external resources. Medical expenses were significantly different for the ICU group, with a 3-times higher average cost than the non-ICU group. Conclusion: Although an individualized approach is needed for each patient in pediatric palliative care, psychosocial care is essential. In addition, if early intervention for end-of-life pediatric patients is available from a palliative care team, the cost burden of medical care for patients and their families should be minimal.

• Journal of Hospice and Palliative Care
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• 제15권4호
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• pp.188-192
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• 2012

Palliative medicine has shown demonstrated benefit for patients with serious illness, their families, and hospital systems. As such, the demand for palliative care services is growing at a fast pace, and health care facilities frequently struggle to develop and implement effective and sustainable methods of providing this care. As with any new system, challenges and barriers naturally exist to instituting palliative care. Undertaking careful assessment, planning, and resource allocation can provide the greatest likelihood of success when developing these novel yet much needed models of care. This summary paper offers a qualitative overview of the potential benefits and the rationale to implement robust palliative care systems. We briefly review the history of palliative medicine in the broadest sense and address several seminal works from the US palliative care literature. Core practices to establish and advance palliative medicine are suggested. Commentary is provided on some of the particular barriers to palliative system development that may need to be addressed in the context of Korean medical culture. Collectively, we hope this overview can contribute to a framework within which such research and development can occur, leading to increasingly effective and sustainable palliative medicine in Korea.

• 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.

• 의학교육논단
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• 제22권3호
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• pp.146-152
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• 2020

Hospice and palliative care (HPC) education is an essential component of undergraduate medical education. Since February 4th, 2018, withholding and withdrawing life-sustaining treatment at the end of life (EOL) has been permitted in Korea as put forth by law, the "Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life." Therefore, Korean medical schools have faced a challenge in providing comprehensive HPC education in order to better prepare medical students to be competent physicians in fulfilling their role in caring for patients at the EOL. There have been considerable variations in the evolution and organization of HPC education across Korean medical schools for the past 20 years. In 2016, all medical schools taught HPC curriculum as a separate course or integrated courses, with the most frequently taught topics including: delivering bad news, pain management, and the concept of palliative medicine. However, the content, time allocation, learning format, and clinical skills practice training of HPC education have been insufficient, inconsistent, and diverse. For this reason, we propose a HPC curriculum containing seven domains with 60 learning objectives in a course duration of over 20 hours based on the Palliative Education Assessment Tool (PEAT) as standard HPC curriculum. Furthermore, we recommend development of a national curriculum for HPC/EOL care education to be organized by the HPC board and managed under the accreditation criteria of the Korea Institute of Medical Education and Evaluation.

• 보건행정학회지
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• 제29권1호
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• pp.40-48
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• 2019

Background: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. Methods: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. Results: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). Conclusion: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.

• 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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• 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 Medicine and Life Science
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• 제16권3호
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• pp.80-83
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• 2019

First of all, this study shows the legal issues of hospice and palliative care, and the legal basis for lifelong medical practice is generally derived from medical, civil and criminal law regulations, and is applied to patients who are severely ill and dying in principle. In addition, those what is particularly meaningful about hospice and palliative care in terms of legal aspects are discussed the determination of the purpose of care and the provision of medical adaptability and adult guardianship, in particular the legal criteria for the work and status of patient representatives. As such, the purpose of care is to form part of the contract of care and to be agreed between the patient and the physician. In addition, the patient may not write to his/her agent in advance, and the patient may admit discretionary powers to his/her agent, but the patient's will is to be considered. In conclusion, the medical institutional ethics committee should play an active role, especially in the case of no-agents/family or no intention of the patient.