• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.163-169
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• 2016

Purpose: The unmet medical service needs of caregivers critically influence their caring for terminal cancer patients, but not much research has been done in this regard. Thus, the purpose of this study is to investigate the association between caregivers' characteristics and their unmet medical service needs. Methods: The survey was conducted with 109 family caregivers of terminal cancer patients admitted to four hospice units. The data were collected from March 2014 through December 2014 using a structured questionnaire. The unmet medical service needs were measured using 14 items which were adopted and modified by authors. Results: Seven areas of unmet medical service needs were shown to be significant. A well-educated group showed stronger needs for counsel about cancer screening and complementary-alternative medicine and health supplement food. A never-smoked group was identified with less need for sexual dysfunction counsel. Counsel about family and personal relations was more necessary for current drinkers and current workers, and less necessary for the married. Insurance counsel was more needed for a no-religion group. Occupation counsel was less necessary for healthy patients. Financial support was less necessary for the married group. Conclusion: Based on the results, it is highly recommended to further investigate the unmet medical service needs of family caregivers for terminal cancer patients and causes of the unmet needs.

• Journal of Hospice and Palliative Care
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• v.20 no.4
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• pp.226-234
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• 2017

Purpose: With the implementation of the Act on Life Sustaining Treatment, hospice-palliative care will be extended to non-cancer diseases including the acquired immunodeficiency syndrome (AIDS). However, there are concerns about negative perceptions and prejudice toward AIDS patients. The purpose of this study was to investigate factors related with willingness to volunteer (WV) for patients with end-stage AIDS among hospice volunteers. Methods: Participants were 326 hospice volunteers from 19 institutions. A self-administered questionnaire was employed to investigate the participants' WV for end-stage AIDS patients, and the questions were answered using an 11-point rating scale. Demographics, volunteer activity, satisfaction with hospice volunteering, knowledge of AIDS, and attitudes towards AIDS patients (i.e., fear AIDS patients, negative attitude towards AIDS patients, personal stigmatization and stigmatizing attitude) were also investigated. A multiple regression analysis was performed to examine factors associated with WV for patients with end-stage AIDS. Results: WV for patients with end-stage AIDS was 2.82 points lower than that for cancer patients (P<0.001). The multiple regression analysis showed that the higher the level of satisfaction with hospice volunteering (P=0.002) and the lower the level of "personal stigmatization" (P<0.001), participants showed greater WV for end-stage AIDS patients. Conclusion: The level of satisfaction with hospice volunteering and "personal stigmatization" were factors associated with participants' WV for patients with end-stage AIDS.

• Journal of Hospice and Palliative Care
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• v.18 no.4
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• pp.314-321
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• 2015

Purpose: It is well known that a terminal cancer condition affects not only patient themselves but their family members because the patients experience a variety of symptoms. This study was aimed to investigate modifiable factors that influence family caregivers' quality of life, depression, and anxiety. Methods: From January 2015 through May 2015, a survey was conducted with 61 family caregivers of hospice patients who were hospitalized in two university hospitals and one municipal hospital in Busan. The questionnaire was consisted of characteristics of family caregivers and patients, the Korean version of the Caregiver Quality of Life Index-Cancer (CQOLC-K), Beck's Depression Inventory II (BDI-II), Beck's Anxiety Inventory (BAI), and patient's symptom controlling scores rated by family caregivers. Results: Family caregivers' depression was associated with religion. Quality of life and depression of family caregivers were also influenced by monthly household income. Patient age was inversely related to family caregiver's quality of life ($r_s=-0.259$, P=0.043). Family caregivers' quality of life was associated with patient's anxiety (r=0.443, P=0.001). Family caregivers' depression was affected by patient's constipation (r=0.276, P=0.046), anxiety (r=0.508, P<0.001), and daytime drowsiness (r=0.377, P=0.005). And family caregivers' anxiety was influenced by patients' sleep disturbance (r=0.276, P=0.046), depression (r=0.297, P=0.031), and anxiety (r=0.357, P=0.009). Conclusion: According to our findings, family caregivers had higher quality of life and less depression and anxiety when symptoms in hospice patients were well controlled.

• Journal of Hospice and Palliative Care
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• v.14 no.2
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• pp.91-100
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• 2011

Purpose: This study was performed to investigate patients' preferences on receiving life-sustaining treatments (LST) and to analyze the relationship between patients' characteristics and LST selection. We also examined any discrepancy between LST patients' choices regarding medical intervention and actual medical intervention given/not given within 48 hours before death. Methods: This cross-sectional study was performed from March 1, 2008 to August 31, 2008 in the Palliative Care Unit of Korea University Hospital. Electric medical records (EMR) of 102 hospice cancer patients were reviewed, and 74 patients with Glasgow coma scale (GCS) ${\geq}$10 at the time of signing the advance medical directives (AMD) were selected for the first analysis. Then, patients alive at the end of this study, transferred to other hospitals or dead within 48 hours were excluded, and the remaining 42 patients were selected for the second analysis. Results: Preferred LST included antibiotics, total parenteral nutrition, tube feeding, transfusion, and laboratory and imaging studies. The relationship between patients' characteristics and LST could not be analyzed due to skewed preferences. LST chosen at the time of signing the AMD and actual medical intervention given/not given in the last 48 hours showed discrepancy in most cases. Conclusion: When making AMD in hospice cancer patients, it is important to consider the time and possibility of changing the choices. Above all, patients must fully understand the AMD. Thus, LST should always be provided with careful consideration of all possibilities, because legal and social aspects of AMD have not been established yet.

• 한국호스피스완화의료학회:학술대회논문집
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• 2004.07a
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• pp.100-102
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• 2004

Under the current medical system, a terminal patient and his/her family who are neglected inevitably face various aspects of crises including not only physical, but also psychological, social, economic, spiritual and legal problems. Nurses often look after many terminal patents with these types of complicated problems. Therefore, educating the nurses who will take care of such patents would greatly reduce stress so the patents end could their lives in peace and without losing their dignity. This research is a quasi experimental study of nonequivalent control group. A pretest-posttest design where a basic education program is developed for nurses, who frequently treat terminal patents, to understand the importance of the role of hospice and to apply their understandings to treat terminal lancer patents. A sample of the nurses were taken from those who were working in general wards at two general hospitals in Seoul during October, 2003${\sim}$December 2003. The study was composed of 46 experimental group and 43 control group. A basic hospice education program was developed by taking emphasized and overlapping parts from advanced practice hospice nurses education course, short-term education course, an extensive literature survey and by consulting three professionals as well. With the group of 5 professors with vast experiences in oncolgy, 5 nursing administrator, 3 nursing practitioner, the tentative first version of the program was developed and reviewed. Afterwards, by utilizing person to person interviews with 2 head nurses experienced with terminal patients, 1 nurse in charge of hospice, 1 nurse on the contents of the program, and a person to person rating on the educating medium by a nurse were performed. The final version of a basic education program was developed after the second revision. The hospice basic education program consists of introduction to hospice, hospice and commucation, management of pain for terminal cancer patients, physical management for terminal cancer patients, socio-psycological caring of terminal cancer patients and management of death and separation. Total education time was four hours organized into 50 minutes of instruction and 10 minutes of break. $Powerpoint^{(R)}$ software was used as the education medium. As research tools, "Knowledge on Hospice" was developed by the author after receiving a review from one expert. "Attitude of Hospice Nursing" was revised Kim(2001)'s attitude measuring tool which was based on Wang(1998), Kwon(1989), Park and Sung(1991)'s tool. "Liability on nursing terminal patients" was used as developed by Zarits(1980) and Mongomory(1985) translated by Lee(1985). For collecting data, preliminary investigation prior to 1 week of the hospice basic education program and post-investigations after 1 week and 4 weeks of the education were carried out for the nurses at a general ward who understood and agreed on the purpose of the program. Collected data were analyzed throughout t-test, $x^2-test$, Manova test and Bonferroni correction in $SAS^{(R)}$ program. The summary of the investigation is as follows: Hypothesis 1: "Educated experimental group would possess more knowledge on hospice compared to the un-educated control group" was supported after 1 (F=12.14, p=.00) and 4 (F=5.3, p=.02) weeks of education. Hypothesis 2: "Educated experimental group would take a positive attitude toward hospice nursing compared to the un-educated control group" was supported after 1(F=3.92, p=.05) and 4(F=5.05, p=.02) weeks of education. Hypothesis 3: "Educated experimental poop would feel less liability compared to the un-educated control group in nursing terminal cancer patients' was rejected. In this study, it was found that knowledge on hospice was significantly important. By applying hospice basic education programs to nurses, the education program helped nurses to take a positive attitude toward terminal patients. It was, however, seen that the education program had no effect on alleviating liability in nursing terminal patients. Therefore, it is expected that this educational program would help hospices and nurses at general wards to understand the concept and the role of hospice so that terminal patents, now neglected under current medical system, would be able to end their lives in peace.

• Journal of Hospice and Palliative Care
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• v.17 no.1
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• pp.27-33
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• 2014

Purpose: Although vitamin D deficiency is more commonly found in cancer patient than in non-cancer patients, there have been little data regarding the prevalence of vitamin D deficiency in cancer patients at the very end of life. We examined vitamin D deficiency in terminally ill cancer patients and related factors. Methods: This study was based on a retrospective chart review of 133 patients in a hospice ward. We collected data regarding age, sex, serum 25-hydroxyvitamin D level, cancer type, physical performance, current medications and various laboratory findings. We investigated factors related to serum vitamin D levels after multivariate adjustment for potential confounders. Serum 25-hydroxyvitamin D<20 ng/mL was considered deficient and <10 ng/mL severely deficient. Results: Ninety-five percent of the patients were serum vitamin D deficient. Severe vitamin D deficiency was more common in male patients, non-lung cancer patients, $H_2$ blocker users and non-anticonvulsant users. Elevated levels of serum alanine aminotransferase (ALT) were also associated with low serum vitamin D levels. Multiple regression analysis showed that severe vitamin D deficiency was associated with male gender (aOR 3.82, 95% CI: 1.50~9.72, P=0.005), $H_2$ blocker users (aOR 3.94, 95% CI: 1.61~9.65, P=0.003) and elevated serum ALT levels (aOR 4.52, 95% CI: 1.35~15.19, P=0.015). Conclusion: Vitamin D deficiency was highly prevalent among terminally ill cancer patients. Severe vitamin D deficiency was more common in male patients, $H_2$ blocker users, and patients with elevated ALT levels.