Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Home-Based Hospice Care Provided by a Free-Standing Hospice Center: Patients' Characteristics and Service Conditions

일개 독립형 호스피스 기관의 가정호스피스 이용자 특성 및 서비스 제공 실태

  • Received : 2015.11.12
  • Accepted : 2016.04.18
  • Published : 2016.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study was conducted to investigate patients' characteristics and actual conditions of home-based services offered by a free-standing hospice center. Methods: A retrospective review was performed with the medical records of 75 patients who received home-based hospice care from a free-standing hospice center from January 2014 through December 2014. Results: Most patients (54.7%) were enrolled via self-directed referral. The reason for the service termination was death at home 25.3%, admission to a hospice ward 50.7%, hospitalization 22.6% and patients' refusal 2.7%. Seventy three patients had cancer, and two patients had ALS. Among all, 58.7% were in a dying phase, and 34.7% were almost completely bedfast at the time of their enrollment in this study. When they enrolled, the patients' physical symptoms were characterized as pain (89.4%), sleep disturbance (71.2%), urinary difficulties (35.8%) and defecation difficulties (47.8%). Among all, 77.4% terminated the home visit service within one month. The mean frequency of the home visits was 3.25 (${\pm}3.98$), and less than five in 82.7% of patients. The mean frequency of the phone service was 3.40 (${\pm}3.12$). The frequency of doctor's home visits was $1.21{\pm}0.79$ on average, and the figure increased when patients' conditions turned unstable. Conclusion: It is necessary to develop a home-based hospice care model with consideration of patients' characteristics and the actual service conditions delivered by free-standing hospice facilities.

목적: 본 연구는 독립형 호스피스기관의 가정호스피스 서비스에 등록한 말기환자의 특성과 가정호스피스 서비스 제공 실태를 파악하여 가정호스피스 서비스 모델 개발을 위한 기초자료를 제공하기 위하여 수행되었다. 방법: 일개 독립형 호스피스기관의 가정호스피스에 등록하여 방문서비스를 받고, 2014년 1월 1일부터 2014년 12월 31일 사이에 서비스가 종료된 말기환자의 의무기록지 75개를 후향적으로 분석하였다. 결과: 등록 환자의 54.7%가 자가 의뢰를 통하여 가정 호스피스를 이용하였다. 종료 후 25.3%가 가정에서 임종하였고, 50.7%는 호스피스병동, 22.6%는 대학병원이나 요양병원으로 입원하였다. 등록 당시 97.3%가 암성질환이었으며, 비암성질환으로 가정호스피스를 이용한 경우는 2.7%였다. 등록 환자의 58.7%가 임종기에 있었으며, 34.7%는 거의 완전한 와상 상태에 있어 전반적으로 낮은 활동수준을 보였다. 등록 당시 환자들이 가진 신체 증상은 통증(89.4%), 수면장애(71.2%), 배변문제(47.8%), 배뇨문제(35.8%) 순으로 나타났다. 전체 환자의 77.4%가 1개월 이내에 서비스가 종결되었다. 환자들에 대한 가정방문 횟수는 평균 3.25회로 전체 환자의 82.7%가 5회 미만의 가정방문을 받고 서비스가 종결되었으며, 전화상담 횟수는 평균 3.4회였다. 의사 방문 횟수는 평균 1.21회였으며, 이는 불안정기에 유의하게 증가하였다. 결론: 독립형 호스피스기관을 이용하는 환자의 특성과 서비스 제공 형태를 반영한 가정호스피스 서비스 모델 개발이 필요하다.

Keywords

References

  1. Davies E, Higginson IJ, eds. The solid facts: palliative care [Internet]. Copenhagen: WHO regional office for Europe; 2004 [cited 2015 Jul 21]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0003/98418/E82931.pdf?ua=1.
  2. Hunt M. ‘Scripts' for dying at home-displayed in nurses', patients' and relatives' talk. J Adv Nurs 1992;17:1297-302. https://doi.org/10.1111/j.1365-2648.1992.tb01851.x
  3. Ryder-Lewis M. Going home from ICU to die: a celebration of life. Nurs Crit Care 2005;10:116-21. https://doi.org/10.1111/j.1362-1017.2005.00117.x
  4. Kerr CW, Tangeman JC, Rudra CB, Grant PC, Luczkiewicz DL, Mylotte KM, et al. Clinical impact of a home-based palliative care program: a hospice-private payer partnership. J Pain Symptom Manage 2014;48:883-92. https://doi.org/10.1016/j.jpainsymman.2014.02.003
  5. Higginson IJ, Sen-Gupta GJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 2000;3:287-300. https://doi.org/10.1089/jpm.2000.3.287
  6. Hunt KJ, Shlomo N, Addington-Hall J. End-of-life care and achieving preferences for place of death in England: results of a population-based survey using the VOICES-SF questionnaire. Palliat Med 2014;28:412-21. https://doi.org/10.1177/0269216313512012
  7. Choi JH, Byeon JJ, Lee S, Han SH. Preferred place of death elderly women in Seoul. J Korean Acad Fam Med 2001;22: 936-45.
  8. Park JY. Home health care services for terminally ill patients and dying at home [dissertation]. Seoul: Yonsei Univ.; 2011. Korean.
  9. Statistics Korea: 2014 Statistics of birth.death [Internet]. Daejeon: Statistics Korea; 2015 [cited 2016 Jan 24]. Available from: http://kostat.go.kr/portal/korea/kor_ko/5/2/index.board?bmode=read&aSeq=334108.
  10. World Health Organization. Cancer control: palliative care. WHO guide for effective programmes Module 5: palliative care [Internet]. Geneva: World Health Organization; 2007 [cited 2015 Jul 21] Available from: http://www.who.int/cancer/publications/cancer_control_palliative/en/.
  11. Ornstein K, Wajnberg A, Kaye-Kauderer H, Winkel G, DeCherrie L, Zhang M, et al. Reduction in symptoms for homebound patients receiving home-based primary and palliative care. J Palliat Med 2013;16:1048-54. https://doi.org/10.1089/jpm.2012.0546
  12. Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD. Prigerson HG. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. J Clin Oncol 2010;28:4457-64. https://doi.org/10.1200/JCO.2009.26.3863
  13. Brumley RD, Enguidanos S, Cherin DA. Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med 2003;6:715-24. https://doi.org/10.1089/109662103322515220
  14. Brumley R, Enguidanos S, Jamison P. Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc 2007;55:993-1000. https://doi.org/10.1111/j.1532-5415.2007.01234.x
  15. Park CS, Yoon SJ, Jung Y. The status of home-based hospice care in Korea. Korean J Hosp Palliat Care 2013;16:98-107. https://doi.org/10.14475/kjhpc.2013.16.2.098
  16. Kang SH, Lee HY, Kim JS, Lee JK, Jung HK. Home-based hospice-palliative care service administered at university-based family practice. J Korean Acad Fam Med 2006;27:889-94.
  17. Kim BH, Kang HJ. Experience of home-based hospice care of terminal-cancer patients. Korean J Hosp Palliat Care 2014;17: 223-31. https://doi.org/10.14475/kjhpc.2014.17.4.223
  18. Koh S, Kim Y, Song MO, Choi Y, Choi SE, Jho HJ, et al. Home hospice palliative care service in Korea: based on focus group interview. J Korean Data & Information Science Society 2014;25:37-52. https://doi.org/10.7465/jkdi.2014.25.1.37
  19. Lee JE, Kim SL. Physical and psychological care need by endof-life stages among non-cancer patient at home: based on the importance and difficulty of care need. J Korean Acad Community Health Nurs 2012;23:127-33. https://doi.org/10.12799/jkachn.2012.23.2.127
  20. Yong JS, Ro YJ, Han SS, Kim MJ. A comparison between home care nursing interventions for hospice and general patients. J Korean Acad Nurs 2001;31:897-911. https://doi.org/10.4040/jkan.2001.31.5.897
  21. Yong JS, Kim NC, Kang JH. Development of nursing intervention standards for home hospice patients. J Korean Acad Adult Nurs 2006;18:102-14.
  22. Lee WH, Lee CG. Development of a clinical protocol for home hospice care for Koreans. Yonsei Med J 2005;46:8-20. https://doi.org/10.3349/ymj.2005.46.1.8
  23. Kim BH, Park H. Comparison in spiritual well-being and quality of life between hospital and home hospice patients. J Korean Acad Community Health Nurs 2013;24:292-301. https://doi.org/10.12799/jkachn.2013.24.3.292
  24. Shin DW, Choi JY, Nam BH, Seo WS, Kim HY, Hwang EJ, et al. The current status of utilization of palliative care units in Korea: 6 month results of 2009 Korean Terminal Cancer Patient Information System. Korean J Hosp Palliat Care 2010; 13:181-9.

Cited by

  1. 제주지역내 재가암환자관리를 받은 환자와 보호자에게 제공되는 프로그램 만족도와 요구 vol.19, pp.8, 2016, https://doi.org/10.5762/kais.2018.19.8.276
  2. 재가 호스피스완화 대상자의 증상 및 돌봄 요구도 분석 -부산광역시 보건소 중심 재가 호스피스사업을 중심으로- vol.12, pp.4, 2016, https://doi.org/10.12811/kshsm.2018.12.4.173
  3. 보건진료소에서의 말기 암 환자 간호사례 vol.15, pp.1, 2016, https://doi.org/10.22715/jkarhn.2020.15.1.30