• Title/Summary/Keyword: Treatment refusal

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Factors Related to Treatment Refusal in Taiwanese Cancer Patients

  • Chiang, Ting-Yu;Wang, Chao-Hui;Lin, Yu-Fen;Chou, Shu-Lan;Wang, Ching-Ting;Juang, Hsiao-Ting;Lin, Yung-Chang;Lin, Mei-Hsiang
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.8
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    • pp.3153-3157
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    • 2015
  • Background: Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. Materials and Methods: This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). Results: A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (${\geq}10times$) (p=0.016). Conclusions: Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

A Study of Low Flux Hemodialysis Noncompliance Indicators and Discriminant Standards, Development of Hemodialysis Noncompliance Measurement - Brief Form(HNCM-BF) (저효율 혈액투석 불이행 측정 도구 개발)

  • Hur, Jung
    • Journal of Korean Academy of Nursing Administration
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    • v.13 no.4
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    • pp.462-472
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    • 2007
  • Purpose: Purpose of the this study is to define the hemodialysis noncompliance Indicators and discriminant standards levels for low Flux Hemodialysis patients and development of Hemodialysis noncompliance measurement - brief form. Method: Data was collected from 269 hemodialysis patients. To establish the hemodialysis noncompliance Indicators and to discriminate standards, 13 hemodialysis nurses and 2 nephrology doctors are participated in professional group. To verify the indicators and discriminant standards, data was ananlyzed by the canonical discriminant analysis method using by SAS 8.3 program. Result: 4 Indicators- interdialysis weight gain(IWG); average of recent 4weeks, serum phophate level, skipping of hemodialysis and hemodialysis time shortening without permission- of hemodialysis noncompliance are established and discriminant standards are developed. Discriminant ability of these 4 noncompliance indicators is 99.7%(p=.000). Hemodialysis noncompliance measurement - brief form has 96.3% discriminant accuracy. Conclusion: Hemodialysis noncompliant patients have high risks. It means that special intervention to noncompliance is needed. Also continuous and objective assessment and standards of noncompliance are needed.

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Concept Analysis of Psychological Resistance to Antihypertensive Medication (고혈압환자의 약물치료에 대한 심리적 저항의 개념분석)

  • Jang, Hee Soon;Kong, Kyoung Ran;Lee, Eun Nam;Kang, Jiyeon;Jang, Moon Jung
    • Journal of Korean Critical Care Nursing
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    • v.9 no.2
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    • pp.48-60
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    • 2016
  • Purpose: The purpose of this study was to identify the attributes of the concept, of psychological resistance to antihypertensive medication. Methods: The study was conducted in accordance with Walker and Avant's conceptual analysis process. We reviewed 47 related studies selected from 4 international and Korean databases including Medline, CINAHL, NDSL, and RISS to perform the analytical processes from January 1980 to September 2015. Results: The attributes of psychological resistance to antihypertensive medication include 1) reservation, 2) opposition, 3) denial, 4) refusal, and 5) seeking alternative therapy. The antecedents of the concept can be classified into patient factors such as reactance trait and knowledge deficit, provider factors, interpersonal factors, and environmental factors. The consequences of psychological resistance to antihypertensive medication are non-compliance, deterioration of the disease, developing complications, increased anxiety, and changes in life. Conclusions: The concept of psycho logical resistance to antihypertensive medication can provide guidance for the development of an intervention program that promotes the compliance to medication regimen of hypertensive patients. Further research needs to be done to develop a measurement tool for psychological resistance to antihypertensive medication.

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Legal Consideration of Transfer Refusal by 119 Rescuers (119구급대의 이송거절 및 거부에 대한 법적 고찰)

  • Bae Hyun-A;Lee Sang-Jin;Kim Chan-Woong;Lee Kyung-Hwan
    • Fire Science and Engineering
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    • v.19 no.4
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    • pp.47-56
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    • 2005
  • The regulation on organization and operation of rescue and aid party was amended. This Regulation is designed to provide legal formality in order to protect not only the patients' right but also 119 rescuers from liability, which is due to treatment refusal by patient and the discretionary refusal of transfer by 119 rescuers on the non-emergency situation. This study looked over the constitute of violation of emergency medical service act related to the discretionary refusal of 119 rescuers, the criminal liability owing to omission and the possibility of national indemnities on the damage of patients. This study also analyzed the courts' decision and attitude by exploring overseas judicial precedents and examined what should be considered on the execution of the newly enacted law. Finally, this study put emphasis on the importance of medical director's control, documentation of every procedure, 119 rescuer's authorization on the refusal of transfer by securing patient's informed consent.

Application and Expansion of the Harm Principle to the Restrictions of Liberty in the COVID-19 Public Health Crisis: Focusing on the Revised Bill of the March 2020 「Infectious Disease Control and Prevention Act」 (코로나19 공중보건 위기 상황에서의 자유권 제한에 대한 '해악의 원리'의 적용과 확장 - 2020년 3월 개정 「감염병의 예방 및 관리에 관한 법률」을 중심으로 -)

  • You, Kihoon;Kim, Dokyun;Kim, Ock-Joo
    • The Korean Society of Law and Medicine
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    • v.21 no.2
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    • pp.105-162
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    • 2020
  • In the pandemic of infectious disease, restrictions of individual liberty have been justified in the name of public health and public interest. In March 2020, the National Assembly of the Republic of Korea passed the revised bill of the 「Infectious Disease Control and Prevention Act.」 The revised bill newly established the legal basis for forced testing and disclosure of the information of confirmed cases, and also raised the penalties for violation of self-isolation and treatment refusal. This paper examines whether and how these individual liberty limiting clauses be justified, and if so on what ethical and philosophical grounds. The authors propose the theories of the philosophy of law related to the justifiability of liberty-limiting measures by the state and conceptualized the dual-aspect of applying the liberty-limiting principle to the infected patient. In COVID-19 pandemic crisis, the infected person became the 'Patient as Victim and Vector (PVV)' that posits itself on the overlapping area of 'harm to self' and 'harm to others.' In order to apply the liberty-limiting principle proposed by Joel Feinberg to a pandemic with uncertainties, it is necessary to extend the harm principle from 'harm' to 'risk'. Under the crisis with many uncertainties like COVID-19 pandemic, this shift from 'harm' to 'risk' justifies the state's preemptive limitation on individual liberty based on the precautionary principle. This, at the same time, raises concerns of overcriminalization, i.e., too much limitation of individual liberty without sufficient grounds. In this article, we aim to propose principles regarding how to balance between the precautionary principle for preemptive restrictions of liberty and the concerns of overcriminalization. Public health crisis such as the COVID-19 pandemic requires a population approach where the 'population' rather than an 'individual' works as a unit of analysis. We propose the second expansion of the harm principle to be applied to 'population' in order to deal with the public interest and public health. The new concept 'risk to population,' derived from the two arguments stated above, should be introduced to explain the public health crisis like COVID-19 pandemic. We theorize 'the extended harm principle' to include the 'risk to population' as a third liberty-limiting principle following 'harm to others' and 'harm to self.' Lastly, we examine whether the restriction of liberty of the revised 「Infectious Disease Control and Prevention Act」 can be justified under the extended harm principle. First, we conclude that forced isolation of the infected patient could be justified in a pandemic situation by satisfying the 'risk to the population.' Secondly, the forced examination of COVID-19 does not violate the extended harm principle either, based on the high infectivity of asymptomatic infected people to others. Thirdly, however, the provision of forced treatment can not be justified, not only under the traditional harm principle but also under the extended harm principle. Therefore it is necessary to include additional clauses in the provision in order to justify the punishment of treatment refusal even in a pandemic.