• Journal of the Korea Academia-Industrial cooperation Society
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• v.22 no.2
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• pp.539-547
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• 2021

This study was conducted to identify the effects of knowledge of Advance Directives (AD) and the patient's perception of a peaceful death on their attitude toward the withdrawal of life-sustaining treatment and to provide basic data for the development of a nursing intervention program for activating self-determination in the withdrawal of life-sustaining support of patients. The subjects were 167 adult cancer patients who received outpatient or inpatient treatment, from September 15, 2019, to March 30, 2020. The data was analyzed by mean, standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression by using SPSS 21.0. From the results, it was observed that the knowledge of AD was 8.87±2.46 out of 12, perception of a peaceful death was 2.87±0.42 out of 4, and attitude toward withdrawal of life-sustaining treatment was 3.46±0.49 out of 5. There was a positive correlation between knowledge of AD, perception of a peaceful death, and their attitude toward withdrawal of life-sustaining treatment. The influencing variables were the knowledge of AD, perception of a peaceful death, discussion with family on withdrawal of life-sustaining treatment, and explanation power was 16.0% (F=10.355, p<.001). Therefore, it is necessary to develop a program that would improve the perception of a peaceful death, increase the knowledge of AD to improve the patients' attitude toward the withdrawal of life-sustaining treatment. An intervention to assist a discussion between the patients and their families in advance would also be useful.

• Proceedings of the Korean Society of Computer Information Conference
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• 2019.07a
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• pp.195-198
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• 2019

연명의료결정법의 정식 명칭은 '호스피스 완화의료 및 임종 과정에 있는 환자의 연명의료 결정에 관한 법'이다. 이 법은 호스피스 완화의료에 대한 것과 환자의 연명의료 결정에 대한 것을 규정하고 있다. 특히, 후자의 연명의료결정에 관한 부분은 법제정 과정에서 법 종교 의료 윤리 등 다양한 분야에서 논박이 있었지만 2018년 2월 4일부터 시행되고 있다. 법학에서는 이 법이 생명이라는 법익과 관련되어 있어 형사법적, 민사법적으로 중요한 의미를 갖는다. 이 법이 탄생되기 위해 두 번의 변곡점이 있었다. 첫째, 1997년 '보라매병원 사건'에서 의사를 작위에 의한 살인방조죄로 판결한 사건 둘째, 2009년 '김 할머니' 사건에서 회생할 수 없을 경우 가족 등이 진술한 환자 의사에 따라 연명 의료를 중단할 수 있다는 대법원 판결이다. 연명의료결정법은 헌법상 생명권과 자기운명결정권이라는 기본권 충돌이 발생한다. 두 기본권이 서로 상충 할 때에는 어떠한 기본권을 우선해야 하는지가 실질적으로 문제되는데, 이익형량을 통한 규범의 조화로운 해석을 통해 해결해야 한다. 또한 이 법의 흠결과 문제점을 고찰하여 개정작업이 진행되어야 한다.

• The Journal of the Korea Contents Association
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• v.21 no.4
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• pp.688-698
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• 2021

The purpose of this study was to determine the effects of perception of good death and knowledge toward advance directive on attitude toward withdrawal of life-sustaining treatment among university hospital nurses. The subjects of this study were 207 university hospital nurses. Data were analyzed using the SPSS Statistics 24.0 version. The results showed that factors influencing attitude toward withdrawal of life-sustaining treatment were perception of good death (𝛽=-.32, p<.001), education experience for good death (𝛽=.15, p=.024), and knowledge toward advance directive (𝛽=.14, p=.036). They explained 14.2% of attitude toward withdrawal of life-sustaining treatment. Based on the results of this study, it suggests the development of education programs for good death and life-sustaining treatment to improve the perception of good death, knowledge toward advance directive of university hospital nurses.

• Journal of Hospice and Palliative Care
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• v.24 no.2
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• pp.74-84
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• 2021

Purpose: This study investigated knowledge of and attitudes toward advance directives (ADs) among middle-aged women in South Korea, their willingness to write ADs in the future, and the factors related to knowledge of and attitudes toward ADs. Methods: Data were collected using a self-administrated questionnaire completed by 154 middle-aged women aged 50 to 64 from February to March 2020. The questionnaire asked about participants' knowledge of and attitude toward ADs, willingness to write ADs in the future, experiences with life-sustaining treatment within their families, experience making decisions about life-sustaining treatment, and demographic characteristics. Results: Scores for both knowledge of and attitude toward ADs were relatively high. About 60% of participants gave wrong answers when asked if attorneys were required for writing ADs. A higher knowledge score was significantly associated with a higher attitude score (r=0.227, P<0.01). The women were more likely to be willing to write ADs in the future when they reported a middle income level rather than a lower income level (odds ratio [OR]=5.952, P<0.01), considered themselves unhealthy (OR=5.873, P<0.01), and graduated college or higher (OR=4.096, P<0.05). Furthermore, women who thought that ADs would have an impact on treatment (OR=1.869, P<0.05) and on their families (OR=1.447, P<0.05) were more likely to be willing to write an AD. Conclusion: This study shows that wrong information about ADs persists among middle-aged women, and significant factors associated with knowledge of and attitude toward ADs were identified. Targeted education programs about ADs need to be developed for middle-aged women.

• Journal of Hospice and Palliative Care
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• v.24 no.2
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• pp.97-108
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• 2021

Purpose: The purpose of this study was to examine the life-sustaining treatment decisions of terminal cancer patients. Methods: Data on 10 terminal cancer patients who decided to withhold or withdraw from treatment were collected using in-depth interviews conducted from February 8 to October 30, 2019. Data were collected until saturation was reached and then analyzed using Colaizzi's phenomenological method. Results: In this study, six thematic clusters were identified: "having complicated feelings", "making choices to protect everyone", "accepting and preparing for death", "feeling distress", "pursuing spiritual wellbeing", and "evaluating the new system". Conclusion: When facing death, terminal cancer patients often made choices to protect their family and their dignity with uneasiness of mind when deciding to withdraw from life-sustaining treatments. Though many patients had accepted and prepared for death, they experienced distress about leaving children behind after death. They also pursued spiritual well-being to find peace after deciding to withdraw from life-sustaining treatment. In addition, participants evaluated the new system of policies pertaining to decisions on life-sustaining treatment. Thus, various approaches regarding acceptance and preparation for death, communication with family, hope, and spiritual comfort should be taken in educational interventions to assist terminal cancer patients as they decide whether to withdraw from life-sustaining treatment.

• Journal of Hospice and Palliative Care
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• v.23 no.2
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• pp.85-92
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• 2020

Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with end-stage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

• Journal of Hospice and Palliative Care
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• v.26 no.2
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• pp.80-94
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• 2023

Purpose: This study aimed to identify attitudes toward advance directives (ADs) among female cancer patients and factors related to ADs. Methods: The study was conducted at a university hospital in Seoul from September 19, 2020, to January 20, 2021. The participants were 153 patients diagnosed with gynecological cancer or breast cancer. Data were collected using questionnaires and included general characteristics, disease- and AD-related characteristics, knowledge and attitudes about ADs, and attitudes about dignified death. Data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results: Only 2% of the participants completed ADs. The mean score for attitudes toward ADs was 3.30, indicating a positive knowledge and attitude toward dignified death. The factors related to attitudes toward ADs were attitudes toward dignified death (𝛽=0.25, P=0.001), experience discussing life-sustaining treatment (𝛽=0.17, P=0.037), preferred time to have a consultation about ADs (𝛽=0.19, P=0.046), intention to write ADs (𝛽=0.15, P=0.038), and Eastern Cooperative Oncology Group Performance Status (𝛽=-0.37, P<0.001). The explanatory power of these variables for attitudes toward ADs was 38.5%. Conclusion: Overall, patients preferred to have a consultation about ADs when they were still active, mentally healthy, and able to make decisions. Education about ADs should be provided to patients on the first day of hospitalization for chemotherapy or while awaiting treatment in an outpatient setting so patients can write ADs and discuss them with family and friends.

• Journal of East-West Nursing Research
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• v.28 no.2
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• pp.142-150
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• 2022

Purpose: The purpose of this study is to identify the factors affecting the role of nurses with regard to the perception of good death, knowledge of advance directives, and stress and attitude toward withdrawing life-sustaining treatment. Methods: Data were collected from 102 nurses working at a general hospital. Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Scheffé test, Pearson correlation coefficient, and multiple linear regression using the SPSS 28.0.1.0 program. Results: Educational level (β=.37, p=.001 for bachelor; β=.33, p=.005 for master or higher) and good death perception (β=.22, p=.024) were significant factors of the role of nurses associated with withdrawing life-sustaining treatment. Conclusion: Based on the result of this study, information about awareness of good death should be included in development of an educational program in order to strengthen the role of nurses in withdrawing life-sustaining treatment of patients.

• Korean Journal of Adult Nursing
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• v.25 no.2
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• pp.207-218
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• 2013

Purpose: The purpose of this study was to explore the chronic patients' preferences for care near the end of life. Methods: This is a descriptive survey research, with subjects of 161 outpatients with hypertension, diabetes mellitus or chronic renal failure. Results: The majority of the subjects do not want meaningless life sustaining treatment and they report thinking positively about family or health care professional to participate in their end of life decision making process. Subjects reported preferring adequate pain management and spiritual support at the end of life. In regard to advance directives (ADs), those subjects with chronic disease report thinking positively about the necessity of ADs and its institutionalization. However, the subjects report not having the detailed information on the proper time and method of writing their ADs. Conclusion: Based on these results, educational programs on end of life decision making for chronic patients need to be developed. Also, the nurse should try to reflect the opinion of chronic patients as much as possible when make an end-of-life decision.

• Journal of Hospice and Palliative Care
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• v.23 no.3
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• pp.126-138
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• 2020

Purpose: In Korea, since the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life was implemented in February 2018, advance directives (ADs) have become legally effective and should be documented after sufficient explanation by a registered counselor. However, little is known regarding the adequacy of current AD counseling. This qualitative study aimed to explore the barriers to AD counseling based on counselors' experiences. Methods: We conducted focus group interviews using purposive sampling. Seven counselors working at hospitals, community health institutions, and non-profit organizations participated in this study. They were asked about the challenges and problems they encountered during AD counseling. Results: Three themes emerged from this study; 1) issues regarding consistency in AD counseling, 2) issues regarding AD counselors' competency and work environment, and 3) issues regarding the adequacy of the service system. The interviewees stated that the lack of a manual for standardized service made AD counseling inconsistent. The limited competency and poor work environment of counselors were pointed out as major barriers. The interviewees also stated that a proper service system considering individual circumstances is absent. Conclusion: The goals of AD counseling should be clarified and guidance should be implemented for providing standardized services. Further efforts to enhance the competency of AD counselors and to improve their working conditions are needed. Establishing an integrated framework for an adequate service system is also essential to overcome systematic barriers to AD counseling.