• Journal of Hospice and Palliative Care
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• 제24권3호
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• pp.184-193
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• 2021

Purpose: This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for life-sustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. Methods: This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. Results: The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). Conclusion: This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

• Journal of Hospice and Palliative Care
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• 제10권3호
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• pp.120-127
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• 2007

Bereavement is the state of loss resulting from death. Grief is the emotional response associated with loss, intense and acute sorrow resulting from loss. Complicated grief represent a pathological outcome involving social, physical, emotional, cognitive, spiritual morbidity. The common psychiatric disorders associated complicated grief or abnormal grief responses include clinical depression, anxiety disorders, alcohol abuse or other substance abuse, and dependence, psychotic disorders, and post-traumatic stress disorder (PTSD). Grief tasks involve a series of stage or phases following an important loss that gradually permit adjustment and recovery. Three phases of grief involve phase 1 (walking the edges), phase 2 (entering the depths), and phase 3 (reconnecting the world). For intervention to be effective they need to be individually tailored to abnormal grief reaction or unresolved grief reaction. Clear understandings of complicated grief, abnormal responses, factors increasing risk after bereavement will often enable us to prevent psychiatric disorders in bereaved patients.

• Journal of Hospice and Palliative Care
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• 제20권4호
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• pp.242-252
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• 2017

목적: 본 연구의 목적은 델파이 합의방식을 통해 '완화의료 도우미'라는 새로운 직종의 직무범위를 개발하는 것이다. 방법: 호스피스 완화의료 실무와 정책에 관여하는 전문가 패널 36명이 참여하였고, 4단계에 걸친 델파이 조사를 통해 각 책무-과업-과업요소의 내용 타당도를 검증하였다. 내용 타당도는 5점 척도에서 4점 이상인 항목을 채택하였다. 결과: 4단계의 델파이 조사결과를 분석하여, 완화의료 도우미의 직무로 책무 4개, 과업 15개, 과업요소 46개를 최종 확정하였다. 결론: 본 연구를 통해 완화의료 도우미의 직무범위가 명시되었으며, 이를 통해 역할갈등과 혼란을 예방하고 서비스의 질 향상에 기여할 것으로 기대한다.

• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.254-260
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• 2021

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.198-211
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• 2020

Purpose: The purpose of this study was to examine the relationships of knowledge, attitudes, and self-efficacy related to palliative care among health care providers (doctors and nurses) in order to provide a basis to develop a training program for health care providers. Methods: A correlational and descriptive study design was used. Participants were recruited from a university-affiliated hospital located in Daejeon and an e-nurse community. After IRB approval, data were collected from July 12, 2018, to September 30, 2018. A total of 169 responses were finally analyzed using version SPSS 24. The data were analyzed in terms of descriptive statistics (frequency and percentage or mean and standard deviation, as appropriate), the t-test, analysis of variance (with the Duncan post hoc test), and Pearson correlation coefficients. Results: Knowledge, attitudes, and self-efficacy were significantly higher in those who had received palliative care training or had been exposed to awareness-raising initiatives. There were positive relationships among knowledge, attitudes, and self-efficacy, with small to moderate effect sizes. Conclusion: Palliative care training for health care professionals is necessary to meet patients' needs. Such programs should take into account not only knowledge about palliative care, but also ways to improve empathy and resolve ethical dilemmas. Interprofessional training would be an excellent option to share therapeutic goals and develop communication skills among multidisciplinary team members.

• Journal of Hospice and Palliative Care
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• 제21권1호
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• pp.1-8
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• 2018

보라매 사건 이후 근 20년이 지나 국가위원회의 권고를 기반으로 연명의료결정법이 2018년 2월 4일 제정 시행되었다. 그러나 법률의 제정 과정에서 이해관계 당사자 및 관련자들의 의견 차이로 일부 내용은 수정 또는 삭제되었으며 제정 막바지에 호스피스 완화의료에 대한 내용이 덧붙여졌다. 이로 인해 국가위원회의 권고에 담긴 내용과는 일부 다르게 법률이 제정되어 여러 문제점들이 나타나고 있다. 그러므로 현행 법률 시행 초반 연명의료결정 수행 현장을 꼼꼼히 모니터링하고 다양한 관련자들의 의견을 잘 청취하여 문제점을 파악하고 해결 방안을 마련하여야 할 것이다. 이를 토대로 법률을 개정하여 입법 목적인 '환자의 최선의 이익을 보장하고 자기결정을 존중하여 인간으로서의 존엄과 가치를 보호'가 충실히 이루어질 수 있도록 하여야 할 것이다.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제7권2호
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• pp.37-45
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• 2001

The hospice movement evolved as an alternative to hospitals as places to die. Recently, the palliative care for dying and hospice has been developed rapidly and placed itself as one of the medical systems. But the studies on hospice program and establishment method in Korea are few or no in comparison with developed countries. Hospice unit within a general hospital is more efficient hospice type than other terminal care establishments, therefor it will be developed rapidly. With this in mind, this study puts elements of architectural planning on the hospice unit for the space requirements. Also, It is investigated the architectural conditions of hospice unit within a general hospital, analyzed the unit space and spatial composition in hospice unit. The purpose of this study is to propose the fundamental data and unit space for architectural plan and design.

• 호스피스학술지
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• 제7권2호
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• pp.6-14
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• 2007

Purpose: Hepatocellular carcinoma is the 3rd leading cause of cancer death in Korea and its prognosis is very poor. We aimed to investigate the clinical characteristics of terminal patients with hepatocellular carcinoma on admission into a hospice unit, and to know if they had received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 62 patients with hepatocellular carcinoma who had admitted, received palliative care, and died in a hospice unit between January 2003 and December 2005. Results: The median age of patients was 56.5 years with 50 men(80.65%) and 12 women(19.35%) and gender ratio(male to female) was 417. Child-Pugh class A, B, and C were 6(9.68%), 22(35.38%), and 34(58.84%) respectively. We divided the patients into two groups and compared, the terminal HCC patients with class C as group I and those with class A & B as group 2. The median time from hospice referral to death was significantly short in group 1 with 15.5 days compared to group 2 with 53 days. Statistically more prevalent symptoms in group I were ascites, dyspnea, peripheral edema, and hepatic encephalopathy with abnormal laboratory findings (jaundice, hypoalbuminemia, or renal insufficiency). There, however, was no significant difference in complications and managements during admission between group 1 and 2. Conclusion: Most terminal HCC patients were often accompanied with chronic liver disease. The length of hospice and palliative care for above patients was not enough to attend them. Therefore, we suggest that proper education and information should be provided to physicians, patients, and their family members for effective hospice and palliative care.

• Journal of Hospice and Palliative Care
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• 제18권3호
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• pp.219-226
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• 2015

목적: 본 연구에서는 가정호스피스 완화의료에 대한 국민의 인식을 파악하고 이 인식과 관련된 요인을 확인하고자 한다. 방법: 2014년 8월 19일부터 30일까지 2010년도 인구센서스를 기반으로 제주도를 제외한 전국에 거주하는 만 20세 이상 성인 남녀 1,500명을 대상으로 온라인 설문조사를 실시하였다. 결과: 가정호스피스 완화의료를 인지하고 있는 대상자는 15.9%였고, 가정호스피스 완화의료 이용 의향이 있는 대상자는 61.3%였다. 가정호스피스 완화의료 인지도에 영향을 미치는 요인이 거주지역, 종교 및 민간보험 가입여부이다. 서울, 광주/전라, 부산/울산/경남에 거주하는 대상자의 가정호스피스 완화의료 대한 인지도는 인천/경기에 거주하는 대상자에 비해 높았다. 종교를 보유한 대상자의 가정호스피스 완화의료 인지도는 종교를 보유하지 않은 대상자에 비해 유의하게 높았으며, 민간보험 가입자의 가정호스피스 완화의료 인지도는 민간보험 미가입자에 비해 높았다. 결론: 가정호스피스 완화의료를 활성화하기 위해서는 호스피스에 대한 국민과 의료진의 인식 개선 방안을 마련해야 한다. 또한 요양기관과 지역사회 보건소가 일정 요건을 갖춘 호스피스 완화의료팀을 구성하여 가정을 방문하여 돌봄을 제공할 수 있는 시스템을 구축하여 법제화하고, 이를 건강보험 수가에 적용하는 방안을 적극적으로 검토해야 한다. 또한, 요양기관과 보건소가 가정호스피스 제공이 어려운 지역에서는 호스피스 전문간호사 중심의 가정 방문 호스피스 센터 설치에 대한 고민도 필요한 시점이다.

• 대한간호학회지
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• 제41권1호
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• pp.9-17
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• 2011

Purpose: The purpose of this study was to develop and implement the Hospice Smart Patient Program and to evaluate its effectiveness. Methods: It was quasi-experimental non-equivalent pre-post study. Breast cancer patients who underwent surgery, chemotherapy or radiotherapy, or who needed palliative care, participated in the study. Participants were divided into two groups, experimental and control groups based on their preferences. The program was developed after literature review and discussion among experts on hospice and palliative care. Participants who were in the experimental group received either face-to-face or phone "Hospice Smart Patient" Service at least once a week for 5 months. Results: There was a significant difference in quality of life and communication skill between the two groups after the service was provided. In addition, participants in experimental group showed improved decision making skills, mastery sense, and understanding of hospice and palliative care, which would be beneficial in improving their quality of life. Conclusion: We have concluded that the "Hospice Smart Patient" Program is useful for cancer patients in decision making, improving self-control and choosing hospice care to improve their quality of life.