Journal of Hospice and Palliative Care

  • 제22권4호
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  • Pages.198-206
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  • 2019
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  • 2765-3072(pISSN)
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  • 2765-3080(eISSN)
한국호스피스완화의료학회 (Korean Society for Hospice and Palliative Care)
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수정된 한글 연명의료계획서(Modified Korean Physician Order for Life-Sustaining Treatment, MK-POLST) 분석을 통한 호스피스 병동 환자의 의료 중재 항목별 선호도 및 충실도 조사

Preference and Performance Fidelity of Modified Korean Physician Order for Life-Sustaining Treatment (MK-POLST) Items in Hospice Patients with Cancer

  • 한지희 (경상대학교병원 내과) ;
  • 천혜숙 (경상대학교병원 간호부) ;
  • 김태희 (경상대학교병원 간호부) ;
  • 김록범 (경상대학교병원 권역심혈관센터) ;
  • 김정훈 (경상대학교병원 내과) ;
  • 강정훈 (경상대학교병원 내과)
  • Han, Ji Hee (Department of Internal Medicine, Gyeongsang National University Hospital) ;
  • Chun, Hye Sook (Department of Nursing, Gyeongsang National University Hospital) ;
  • Kim, Tae Hee (Department of Nursing, Gyeongsang National University Hospital) ;
  • Kim, Rock Bum (Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital) ;
  • Kim, Jung Hoon (Department of Internal Medicine, Gyeongsang National University Hospital) ;
  • Kang, Jung Hun (Department of Internal Medicine, Gyeongsang National University Hospital)
  • 투고 : 2019.08.04
  • 심사 : 2019.11.11
  • 발행 : 2019.12.01
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초록

목적: 호스피스 및 완화치료 환자 또는 임종단계 환자를 위한 연명 치료 결정에 관한 법안은 2016년에 제정되어 2018년 2월부터 시행 되었다. 이 법안의 취지와 내용은 미국의 POLST에 근거한다. 이 연구의 목적은 미국의 POLST를 변형하여 만든 MK-POLST를 호스피스 병동 환자들에게 적용을 한 뒤 각 항목에 대한 선호도 및 시행 일치율을 조사하는 것이다. 방법: 2017년 2월 1일부터 2019년 4월 30일까지 경상대학교병원의 부속 호스피스 병동의 모든 입원 환자의 MK-POLST에 대한 의무기록을 후향적으로 분석하였다. 결과: 총 387명의 연구대상자 중 295명의 환자가 MK-POLST를 작성했다. MK-POLST는 환자 자신이 133건(44.1%), 배우자가 84건(28.5 %), 자녀가 75건(25.4%) 작성했다. MK-POLST가 작성된 295 명의 환자 중 단 13명(4.4%)이 주사 영양제를 거부하였으며, 5명(1.7%)은 완화적 진정을 거부하였지만, 대다수인 288명(97.6%)이 심폐소생술 및 인공호흡기 치료를 원하지 않았고, 226명(76.9%)이 승압제 사용을 원하지 않았다. 인공호흡기, 심폐소생술 및 완화적 진정을 제외한 모든 MK-POLST 항목의 시행 일치율에 대한 Kappa 값은 낮았다. 결론: 호스피스 환자들은 심폐소생술, 인공호흡기 및 승압제 사용은 거부 했지만, 대조적으로 항생제, 주사 영양제 및 완화적 진정은 대다수 또는 절대적인 경우에 선호했다.

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward. Methods: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital. Results: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MK-POLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation. Conclusion: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients.

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