• Journal of Hospice and Palliative Care
• /
• v.3 no.2
• /
• pp.144-151
• /
• 2000

Purpose : This investigation was to identify the relationship of social support, stress, health and quality of life in caregivers of home-stay cancer patient. Method : We used a questionnaire and obtained data from the records of 79 caregivers of home-stay cancer patient in a community. Window SPSS-PC was used for the data analysis and the statistical method used were the t-test, ANOVA and Pearson's correlation coefficient. Result : The mean score of family support(3.24) was higher than nurse's support(3.03). The mean score of stress was 3.52 and that of health status was 2.98. The mean score of quality of life was 2.34. The health status of caregivers of cancer patient was influence by age(F=3.17, p=0.018) and education(F=3.59, p=0.032). There was a correlation between nurse's support and family support(r=.263, p<0.05). There was a correlation between stress and health status(r=0.597, p<0.01). The quality of life was correlated with stress(r=-.678, p<0.01) and health status(r=-0.741, p<0.01). Conclusion : The above result indicate that we must consider of social support, stress and health status to promote of quality of life of the caregiver of cancer patient.

• Journal of Hospice and Palliative Care
• /
• v.19 no.1
• /
• pp.26-33
• /
• 2016

Purpose: This study was conducted to identify clinical characteristics of oncologic patients at a point when they signed their do-not-resuscitate (DNR) orders. Methods: From January through December 2014, we retrospectively analyzed the records of 197 patients who passed away after agreeing to a DNR order in the hemato-oncology department of a tertiary hospital. Results: Of all, 121 patients (61.4%) were male and 76 (38.6%) were female, and their average age was 58.7 years. Ninety-four patients (47.7%) had gastrointestinal cancer. The ECOG performance status at admission was grade 3 in 76 patients (36.5%) and grade 4 in 11 (5.6%). The patients' mean hospital stay was 20 days. The mean duration from the admission to DNR decision was 13 days, and the mean duration from DNR decision to death was seven days. Conclusion: Study results indicate that a decision on signing or refusing a DNR order was made by medical staff mostly based on the opinions of patients' guardians rather than the patients themselves. This suggests that patients' own wishes are not well respected. Thus, it is urgent to establish institutional devices to enhance cancer patients' autonomy regarding DNR and to define an adequate timing for withdrawal of treatments.

• Journal of Hospice and Palliative Care
• /
• v.19 no.1
• /
• pp.34-44
• /
• 2016

Purpose: The purpose of this paper is to identify a theoretical basis of end-of-life care by examining attributes of the concept of the nurses' acceptance of patient deaths. Methods: Walker and Avant's approach to concept analysis was used. A literature study was performed to check the usage of the concept. To identify the attributes of the concept and come up with an operational definition, we analyzed 16 qualitative studies on nurses' experiences of death of patients, published in a national science magazine from 1999 to 2015. Results: The nurses' acceptance of death of patients was identified as having four attributes: acceptance through mourning, attaining insight on life and death while ruminating life, facing with fortitude and practicing human dignity. Antecedents of the concept were experiences of patient's death, confusion and conflict, negative emotions, passive responses, denial of patients' death. The consequences of the concept were found as the holistic end-of-life care and active pursuit of life. Conclusion: This study on the attributes of the concept of the nurses' acceptance of death of patients and it's operational definition will likely lay the foundation for applicable end-of-life care mediations and theoretical development.

• Journal of Hospice and Palliative Care
• /
• v.19 no.1
• /
• pp.45-60
• /
• 2016

Purpose: This study is aimed at understanding the volunteers' experiences and interactions with their corresponding teams during their participation in hospice care. More specifically, the study is to contribute policy-wise to development of hospice care in Korea by helping policy-makers and organizers and managers of hospice care provides better understand the importance of the meaning and roles of volunteers in hospice care. Methods: In-depth interviews and participant observation were performed with study participants who were selected from four different types of hospice agencies. Study analysis was conducted using "case study" as one of the rigorous qualitative research methods to develop "inter-" and "intra-" comparisons among the study participants. Results: Volunteers in hospice care were initially motivated by religion and faith, and the motivation grew stronger through the volunteer experiences. They emphasized that the essence of the hospice volunteering was motivation from religion and faith and something they do for themselves. They characterized their experience as a true service that is offered for free and a job that requires expertise. In addition, they achieved personal (internal) growth by reflecting on the meaning of "good death" and better understood the importance of respecting spiritual diversity. Conclusions: This study could help hospice officials offers better understand hospice volunteers' role and their importance. The study also provide practical implications and policy suggestions.

• Journal of Hospice and Palliative Care
• /
• v.16 no.3
• /
• pp.166-174
• /
• 2013

Purpose: This study aims to identify factors that influence middle-aged men's attitude towards death. Methods: The study enrolled 204 middle-aged (range=40~59 years) male residents of Daegu in Korea. Using a structured questionnaire, data were collected in October 4~30, 2010. For data analysis, we used descriptive statistics, t-test, one-way ANOVA, Scheff$\grave{e}$'s test, Pearson correlation coefficient, and stepwise multiple regression with SPSS WIN 14.0. Results: Participants' attitude towards death significantly differed according to educational level, religion, volunteer activities, and perceived health status. Moreover, their attitude towards death was negatively correlated with life stress and depression and positively correlated with self-esteem, life satisfaction, and coping behavior. The factors influencing the attitude towards death were life satisfaction, daily stress, religion, and depression, which explained approximately 25.7% of the total variance. Conclusion: Middle-aged men perform a crucial role in our society, and their attitude toward death affects how they cope with a situational crisis such as a terminal cancer or withdrawal of life sustaining treatment. Therefore, it is necessary to develop and implement a support program for middle-aged men, which offers them with various strategies to better manage their daily stress and improve their life satisfaction and coping skills.

• Journal of Hospice and Palliative Care
• /
• v.16 no.3
• /
• pp.139-144
• /
• 2013

Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.

• Journal of Hospice and Palliative Care
• /
• v.18 no.1
• /
• pp.25-34
• /
• 2015

Purpose: This study is to find relationship between cancer patient's spiritual health and the level of their anxiety and pain. Methods: From April 27 through May 11, 2012, a survey was conducted with 167 cancer patients hospitalized at a university hospital in Busan. Spiritual health was measured by the Spiritual Health Inventory developed by Highfield (1992). The instrument for anxiety measurement was the State-Trait Anxiety Inventory by Spielberger (1975) and that for pain was the Visual Analogue Scale (2009). The association between patients' characteristics and spiritual health, anxiety or pain degree were analyzed using the ANOVA test. The interrelationship between spiritual health, anxiety and pain was analyzed using Pearson's correlation coefficients. Results: The patients exhibited a moderate degree of spiritual health and anxiety and a mild level of pain. Patients' spiritual health significantly differed by their religion, education, monthly income of the family, illness conditions, physical conditions, metastasis, daily living and support. Their anxiety level was significantly different according to age, religion, education, illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. Significant differences were also found in the level of pain according to illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. We found a moderately negative correlation between spiritual health and anxiety. Anxiety and pain showed a positive correlation, and spiritual health and pain exhibited a negative correlation. Conclusion: To help cancer patients to manage their spiritual health, anxiety and pain, a program should be developed considering the primary factors discussed in this study.

• Journal of Hospice and Palliative Care
• /
• v.18 no.1
• /
• pp.1-8
• /
• 2015

Breakthrough cancer pain is a transient exacerbation of pain that occurs despite relatively well controlled background pain with around-the-clock analgesia. It is highly prevalent in patients with cancer pain, with an overall prevalence of 70~90%. Breakthrough cancer pain has several negative effects on quality of life, including a decrease in functional status and social relationship, and higher incidence of anxiety/depression. It also places a detrimental burden on their families, society, and the healthcare system. According to the pathogenic mechanism, breakthrough cancer pain is classified into two categories: idiopathic (or spontaneous) pain and incident pain. Episodes of breakthrough cancer pain have typical characteristics, including rapid onset (5~10 min), severe intensity, and short duration (30~60 min). However, there are some variations in timing and severity of pain among patients and episodes. Therefore, a thorough assessment of pain episodes is needed and management plan must be individualized to provide optimal treatment. Several immediate-release formulations such as oxycodone, morphine, and hydromorphone are widely used despite relatively slow onset of action. Recent studies have shown that transmucosal fentanyl preparations were effective for faster control of breakthrough pain. We hope to improve management of breakthrough cancer pain with more efficient analgesics in line with currently available evidence.

• Journal of Hospice and Palliative Care
• /
• v.18 no.1
• /
• pp.35-41
• /
• 2015

Purpose: This study was conducted to examine how patients' coping style and social support affect post-traumatic stress disorder (PTSD) in breast cancer patients who are treated with chemotherapy. Methods: The sample consisted of 134 outpatients who received breast cancer treatments at the cancer clinic of a university hospital. The collected data were analyzed by frequency, percentage, t-test, ANOVA, ${\chi}^2$-test, Pearson correlation coefficients using SPSS for Windows, version 18.0. Results: Among total, 26.9% of patients were classified into a high-risk PTSD group. In the high-risk group, a positive correlation was found between active and passive coping styles and between social support and active coping styles. Conclusion: In this study, the stronger the social support was, the more active the coping style was for high-risk PTSD patients with breast cancer. Considering the fact that cancer requires life-long self-management, strong social support could improve patients' healthcare capability. Furthermore, solid social support could effectively reduce the stress level and improve the quality of life for breast cancer patients in the high-risk PTSD group.

• Journal of Hospice and Palliative Care
• /
• v.18 no.1
• /
• pp.16-24
• /
• 2015

Purpose: This study was conducted to describe and compare how emergency room (ER) nurses and coroners perceive good death and their attitudes toward death. Methods: A survey was performed with 51 ER nurses in P city and 44 coroners nationwide. Data were collected from October 1, 2010 through February 28, 2011. Data were analyzed with descriptive statistics, t-test, ANCOVA, Scheffe's test using the IBM SPSS statistics 21.0 program. Results: For the perception of good death and attitudes toward death, coroners scored higher ($3.01{\pm}0.43$ and $2.87{\pm}0.35$, respectively) than ER nurses group ($2.95{\pm}0.40$ and $2.61{\pm}0.33$, respectively), but the differences were not significant. The results of perception of good death and attitudes toward death were not statistically significant between ER nurses and coroners. Conclusion: The study showed no difference between ER nurses' perception of good death and attitudes toward death and those held by coroners. The findings of the study show that it is necessary to offer steady education on death to nurses and coroners to help them build a proper understanding of good death and grow positive attitudes toward death.