• Journal of Hospice and Palliative Care
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• v.15 no.4
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• pp.193-204
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• 2012

Purpose: This correlation study was performed to examine Korean adults' perceptions and attitudes towards death with dignity and the withdrawal of life sustaining treatment and to identify factors that predict their attitude towards death with dignity. Methods: The study was conducted using convenience sampling of 291 adults from three towns of a metropolitan city in Korea. Data were collected using structured questionnaires which surveyed people's perception about and attitudes towards withdrawal of life sustaining treatment and scaled their attitude towards death with dignity. Data were analyzed by using descriptive statistics, Pearson correlation coefficients and multiple regression. Results: The attitude towards the withdrawal of life sustaining treatment and death with dignity showed a significant positive correlation (r=0.49, P<0.001). For attitudes towards death with dignity, significant predictors were attitudes towards the withdrawal of life sustaining treatment, age, religion, a proper withdrawal process and advanced medical directives, which explained 49.3% of total variance. Conclusion: The results of this study may contribute to development of a new medical decision-making system including nurses' appropriate roles in the process of withdrawing life sustaining treatment and advanced medical directives.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.25 no.3
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• pp.204-214
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• 2018

Purpose: This study aimed conducted to investigate biomedical ethics awareness and attitudes toward dignified death and advance directives among nursing students. Methods: Data were collected through structured questionnaires from 222 nursing students with clinical practice experience, from November 7 to 23, 2015. Data were analyzed by independent t-tests, one-way ANOVA, Kruskal-Wallis test, and Pearson's correlation coefficients using SPSS WIN 22.0. Results: The scores for biomedical ethics awareness and attitudes toward dignified death were 2.89 and 3.15, respectively. Regarding attitudes toward advance directives (ADs), most students agreed with writing ADs. The main reason given for writing ADs is "I want to receive my treatment of choice." As for the range and explanation method for ADs, 45.7% of participants responded, "do not know well." Regarding willingness toward life sustaining treatment, "only pain control, no life sustaining treatment" was indicated by 83.4% and, "all information about symptoms and prognosis" by 91.9% of participants. For willingness to write ADs, 70.0% of participants responded "yes." Conclusion: Curriculum for nursing ethics should be included in clinical training courses to improve related courses and provide an opportunity to deal with practical problems, such as biomedical ethics, death with dignity, and ADs.

• Research in Community and Public Health Nursing
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• v.28 no.3
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• pp.291-301
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• 2017

Purpose: This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients. Methods: A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. Results: The participants' knowledge level on advance directive was $5.47{\pm}2.08$ out of 9, the attitudes towards the withdrawal of life-sustaining treatment was $3.22{\pm}0.49$ out of 5, and the quality of life was $3.35{\pm}0.92$ out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036). Conclusion: According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.

• Journal of Korean Clinical Nursing Research
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• v.26 no.1
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• pp.86-96
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• 2020

Purpose: The purpose of study was to provide basic data for developing interventions that could help middle-aged adults prepare for dignified death in the future by examining their attitudes toward death and advance directives (AD), and knowledge of AD. Methods: Data were collected through a survey of 211 middle-aged adults from January 28 to February 28, 2019, in a city located in Gangwon Province. To analyze the data, descriptive statistics, t-test, one-way ANOVA, Scheffé test, Pearson's correlation coefficient and stepwise linear regression were utilized using SPSS/WINdows 21.0. Results: The average score of the participants' attitudes toward death and AD, and knowledge of AD was 91.82±10.89, 15.53±4.27, 46.00±9.45, respectively. There were positive correlations between attitudes toward dignified death and attitudes toward AD, and knowledge of AD. Factors that influence attitudes toward AD were shown in the order of attitudes toward dignified death, knowledge of AD, and intentions to write AD (Adjusted R²=.24). Conclusion: For the dignified death in the future, it is necessary to provide middle-aged adults with an opportunity to think about the need of AD. In addition, extensive education and promotion of AD are required to correct the misunderstanding of AD.

• Journal of Hospice and Palliative Care
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• v.18 no.1
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• pp.42-50
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• 2015

Purpose: This study was aimed to analyze how social workers understand the rights for elderly patient and family caregiver to make end-of-life (EOL) care decisions and their roles the decision making process. Methods: The study employed a quantitative research method of collecting data from a structured questionnaire that was filled out by 334 social workers at long-term care facilities. Data were analyzed by descriptive statistics, mean differences, correlation between variables, using SPSS 20.0 program. Results: The mean score for the understanding the rights to an EOL care decision was $3.46{\pm}0.69$ and of their own roles $3.48{\pm}0.84$. The level of understanding significantly differed by social workers' experience of assisting a process to make an EOL care decision such as advance directives and life sustaining treatment, work experience, and the number of beds. Positive correlation was observed between the level of understanding of the rights for EOL care decisions and of social workers' roles (Pearson r=0.329, P<0.001). Conclusion: This study proposes development of an education program for social workers and devising standards for the EOL care decision making process to protect elderly patients, family caregivers as well as social workers in a long term care facility.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.66-74
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• 2014

Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

• Journal of East-West Nursing Research
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• v.20 no.2
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• pp.103-111
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• 2014

Purpose: The purpose of this study was to identify the characteristics of life-sustaining treatment and attitudes towards advance directives among geriatric patients. Methods: The elderly participants (N=146) were recruited from a university hospital from October 30, 2012 to March 31, 2013. A questionnaire for collecting data of participants' characteristics, their experiences related to life-sustaining treatment, and attitudes towards advance directives was used. The data were analyzed using SPSS WIN 17. Results: Most participants (84.9%) were in favor of advance directives. Although most of participants wanted to receive CPR for sudden cardiac arrest (78.8%) and pain control medication (74.0%), most preferred to refuse life-sustaining treatments such as tracheostomy (96.6%) or ventilator (87.0%). Participants who had a family or acquaintances with CPR experiences (U=852.00 p=.038), had discussed with their family and acquaintances regarding end-of-life sustaining treatment (t=2.91, p=.004), or made decisions about refusing the life sustaining treatments (t=3.19, p=.002) preferred to have advance directives than those who did not. Conclusion: The findings of this study suggested the potential benefits of educational programs about advance directives for the end-of-life for geriatric patients to make decisions for life-sustaining treatments in advance.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.9
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• pp.432-439
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• 2019

This study was a qualitative study that attempted to find out the meaning of preparation for dying well that the elderly think through a question of how to prepare for dying well. The focus group interview was conducted on 10 elderly people aged 65 or older who visited the elderly welfare center in B city, Gyeonggi-do, and a total of two groups were interviewed with five subjects as one group. As a result, eight themes were drawn from four dimensions of physical, psychological, social, and spiritual aspects. In physical preparation, 'health management' and 'doing what you want to do' were derived. In psychological preparation, 'not regretting' and 'giving to others' were derived, and in social preparation, 'organizing property', 'determining a place of death you wish', and 'writing a letter of advance life sustaining care directives' were derived. In spiritual preparation, 'relying on religion' was derived. The elderly were preparing for well-being in various aspects, and when developing a program for well-being, the program should be planned to prepare for actual death in various aspects.

• Korean Journal of Clinical Pharmacy
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• v.31 no.2
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• pp.145-152
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• 2021

Background: The Life-Sustaining Treatment Decision-Making Act has allowed anyone aged 19 or older to sign an Advance Directive not to receive life-sustaining treatment when they are in the 'death process'. Recently, the Korean Pharmaceutical Association announced to raise awareness of the Advance Directive to the general public through community pharmacies across the country. This study aimed to investigate the public's willingness to accept pharmacist's consultation regarding the Advance Directive and to present future directions to pharmacists Methods: This cross-sectional questionnaire study using 16-items was conducted in adults, Study subjects were recruited by convenience sampling method during August 5-15, 2020. Results: Of 460 respondents, 51.7% were younger than 30-year-old and 58.7% were not in the healthcare field in terms of job or major. 60.2% knew about the Advance Directive and 81.7% agreed the necessity to sign when healthy. 50.0% had the willingness to consult with pharmacists on the Advance Directive for well-dying and 80.4% preferred verbal explanation together with written information. Simple linear regression analysis results showed a significant relationship between trust in pharmacists or satisfaction with pharmacist's communication and willingness to use pharmacist' consultation on the Advance Directive (1-point increases in values measured on a five-point scale are associated with 0.464 and 0.486 increases, respectively.) Conclusion: This study suggests that pharmacists need to improve the public's trust and communication capability to satisfy with public's demands on well-dying service.