• 호스피스학술지
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• 제3권2호
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• pp.1-11
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• 2003

Purpose: The purpose of this study was to find out the effect of hospice home care on the pain relief and quality of life of terminal cancer patients. Method: Experimental pre and post tests were provided to a single group to see the changes of quality of life of patients who were referred to a hospice home care department after having cancer treatment. They were visited at least 8 times for the duration of 4~6 weeks and were provided a 24 hour phone call service. 41 subjects were transferred to a hospice home care department after being discharged from hospital were selected. Result: 1)The first hypothesis that "the pain score of the subjects after receiving hospice home care would be different from before receiving hospice home care would be different from before receiving hospice home care" which scored 4.06 point at the first test and 3.41 at the second did not statistically show a significant difference(t=1.421 p=1.66), even though the pain score is decreased. 2)The 2nd hypotheses that "the quality of life score of the subjects after receiving hospice home care would be different from before receiving hospice home care" which scored 2.88 point at the first test and 3.39 at the second showed a significant difference(t=-6.759, p=.000) and was supported. Regarding the changes of quality of life score, social aspect(t=-5.745, p=.000), emotional aspect(t=-5.684, p=.000), and spiritual aspect(t=-6.889, p=.000) has significantly been increased, while physical aspect has been more decreased significantly than before the hospice home care is provided(t=4.282, p=.000). Conclusion: It was effective to provide hospice home care in relieving the terminal cancer patients' pain and in improving their quality of life, even though a short term hospice home care for 4-6 weeks was provided.

• 융합정보논문지
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• 제11권1호
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• pp.45-53
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• 2021

본 연구는 만성 심폐질환을 가진 말기 노인환자를 대상으로 연명의료결정 전후에 제공된 완화간호의 빈도와 변화를 파악하기 위한 후향적 조사 연구이다. 일개 대학병원 내과계 병동에 입원한 말기 심폐질환 노인환자 124명의 전자 의무기록을 조사한 결과, 연명의료결정 이후에 경구진통제 투여, 통증 경감을 위한 냉온요법과 마사지요법, 요로감염 시 약물투여와 소변 배양검사, 구강간호, 세발간호, 부분목욕의 제공은 유의하게 감소한 것으로 나타났다. 통증 경감을 위한 기도 및 이완요법, 호흡곤란 시 구·비강간호, 정서적 간호 제공은 연명의료결정 전후에 유의한 차이가 없었으며, 영적 간호는 전체적으로 가장 적게 제공된 것으로 나타났다. 따라서 심폐질환을 가진 말기 노인환자를 대상으로 연명의료결정 이후에 비약물적 통증관리와 안위간호의 개선이 필요하겠다.

• 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.

• 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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• 제25권1호
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• pp.1-11
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• 2022

The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for end-of-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified "terminal stage." The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients' wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient's judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients' right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.

• Journal of Hospice and Palliative Care
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• 제26권3호
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• pp.145-148
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• 2023

Preserving dignity is a significant concern for individuals approaching the end of their lives, as they face an increasing number of conditions that can potentially compromise their dignity. This article discusses dignity therapy as one intervention method aimed at enhancing the psychological and spiritual well-being of patients with terminal illnesses. Dignity therapy is an empirically supported therapeutic intervention that interviews patients with nine questions about what is important to them and what they want to remember, culminating in the production of a document based on these conversations. This intervention serves as a valuable tool and framework, enabling clinical professionals to reflect on dignity. It also provides clinicians with a medium to connect with patients on a deeply human level.

• 대한간호학회지
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• 제26권3호
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• pp.668-677
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• 1996

This study is a phenomenological study done to promote understanding of the dying process in patients with terminal cancer who were in an independent hospice center. The purpose of study was to explore and understand indepth information on the dying process in order to provide data for holistic hospice care in nursing and to give insights in to practical applications in the nursing care In-depth interviewing was done from may, through November, 1995 with 11 patient with cancer who were being cared for at K Hospice Care Center. Experiences in the dying process were discussed as they expressed feelings about death including (a) feeling of isolation because family members try to hide the diagnosis of cancer. (b) hopelessness, (c) guilt, anger, and hostility, (d) suffering from pain, (e) fear of death. However, subjects did not deny death itself and were developing peace of mind and acceptance of death through religion.

• Journal of Hospice and Palliative Care
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• 제15권4호
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• pp.183-187
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• 2012

말기암환자에 대한 완화의료의 중요성은 세계적으로 강조되고 있다. 이에 우리나라에서는 암정복10개년계획을 수립하면서 암에 대한 정책을 기획하였고, 추진되었다. 말기암환자 완화의료사업에 대한 법적 근거를 제시하는 암관리법과 제2기 암정복10개년 계획의 내용을 통해 현재 우리나라의 호스피스 완화의료 제도화 현황을 확인해보고자 한다. 호스피스 완화의료의 제도화는 국가암관리사업의 커다란 틀 안에서 발전되어 왔다. 완화의료기관의 확대 및 전문인력 양성과 질적 향상 등에 대해 2013년 완화의료 수가 본 사업이 시작된 이후에도 호스피스 완화의료의 지속적인 발전을 위하여 발전해야 할 것이다.

• Journal of Hospice and Palliative Care
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• 제2권2호
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• pp.109-113
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• 1999

목적 : 말기 암 환자들을 위한 적절한 의료서비스가 제공되지 않음에 따라 비정상저인 의료행태가 발생되고 있어 말기 암 환자의 관리를 위한 포괄적인 프로그램의 필요성이 제기되고 있다. 고가의 생명유지장치의 무익성과 말기 암 환자 관리의 고 비용에 대한 관심이 늘어나고 있다. 본 연구는 의료보험에서 말기 암환자들에게 지출된 의료비용을 분석하고자 하였다. 방법 : 1997년 1월부터 1998년 6월까지 사망한 암 등록환자 중 공무원 교직원 의료보험 자료 이용이 가능한 151명의 급여내역을 추출하여 입 내원 일수와 의료보험 진료비를 조사하였다. 결과 : 사망 전 6개월 동안의 암 환자 일인당 평균 입원일수는 39일 외래일수는 14일이었다. 진료 일당 평균 진료비는 85,362원이었으며 입원 일당 평균 진료비는 105,908원, 외래 내원 일당 평균 진료비는 40,173원이었다. 진료비의 95%가 종합병원에서 지출되었으며, 진료비의 85%가 입원을 통해 지출되었다. 사망 전 6개월 동안의 진료비는 점차 증가하는 경향을 보여 사망에 가까울수록 사망 전 2개월 동안에 약 50%, 1개월 동안에 약 30%가 지출되었다. 외래진료비는 사망 전 3개월 전까지는 증가하다가 2개월 전부터는 감소하는 반면, 입원진료비는 사망에 가까울수록 증가하는 경향을 보였다. 결론 : 본 연구의 사망 전 6개월간의 의료비 분포는 미국의 메디케어의 자료와 비슷한 분포를 보였다. 향후 보다 큰 규모와 세부적인 진료서비스 내용의 분석을 통해 말기 암 환자의 관리에 대한 정책적 대안을 제시할 필요가 있다.

• Journal of Hospice and Palliative Care
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• 제6권2호
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• pp.180-185
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• 2003