• Journal of Hospice and Palliative Care
• /
• v.13 no.1
• /
• pp.7-12
• /
• 2010

Purpose: To evaluate medications at the end of life care for terminal cancer patients during their last admission. Methods: Medical records of terminal cancer patients during their last admission from July 2003 to April 2008 at a district academic hospital were evaluated. Patient's characteristics, therapeutic drug classification during their last admission and on the patient's day of death, and the administrated route and number of medications on the patient's day of death were analyzed. Results: Total 81 patients were included. The median patient age was 63 years. The median length of admission was 18 days (range: 1~101). 54% of the patients had more than one comorbidities. The most frequently prescribed drugs during the last admission were opioid analgesics (63%), followed by antibiotics (58%) and antacids (53%). On the day of death, common medications were antibiotics (59%), antacids (58%), and opioid analgesics (46%). Intravenous injection was given to 81% of the patients and intramuscular injection was given to 16% of the patients on the day of patient's death. Number of medications prescribed to patients was between 0 and 11 (median: 3) and 12% (10/81) of the patients took over 8 medications including intravenous and oral drugs on the day of death. 6% (5/81) of the patients took potentially futile medications, like multivitamin or statin until the day of death. Conclusion: This study suggests that potentially futile medications and uncomfortable care were given to terminal cancer patients. Multicenter-based studies are necessary to diminish futile medications by essential medication at the end of life care for terminal cancer patients.

• Journal of Hospice and Palliative Care
• /
• v.2 no.2
• /
• pp.101-108
• /
• 1999

Purpose : The purpose of this study was to identify hospice volunteers' perception of the death. Methods : This study was conducted with 327 adults who registered for the hospice volunteer education program in Severance Hospice Center from 1996 through 1999. The 4-years data was collected through a self-reporting questionnaire constructed and revised by the authors. The questionnaire was classified into 5 categories. The data collected were analyzed using SPSS/W. Results : 1) Hospice volunteers were mostly female(93.9%) with an average age of 48 years. The majority(82.6%) of the participants were Protestant. 2) From the 4-years data over 90 percent of participants thought of death as a process of life and responded positively to these three items : 'Death is a temporary separation from family', 'I will die in peace', 'Faith in God results in a freedom from fear of death'. 3) Age were statistically relevant to the following items: 'I often read the obituaries in the newspaper', 'Dying is a tragedy', and 6 items were significantly related to religion: 'I rarely think of dying unexpectedly', 'Death is a temporary separation from family'. 'Dying is a tragedy', 'We have to do our best to prolong life by use of modem medical technology', 'I feel comfortable thinking of death and dying, 'Faith in God results in a freedom from fear of death'. The finding that religiosity was related to perception of death is consistent with other reports. And $40{\sim}50$ year old Protestant women had more positive perception of death than $20{\sim}30$ year old women. Conclusion : The findings indicated an importance of considering the age and religiosity when we educate the hospice volunteers. And that will be a important basic-data to develope program for hospice volunteers.

• Journal of Hospice and Palliative Care
• /
• v.10 no.1
• /
• pp.29-34
• /
• 2007

Purpose: The purpose of this study was to show the differences of medical cost between hospice and non-hospice care for terminally ill patients. This information provides basic data to nationally institutionalize hospice care for decreasing costs and enhancing quality of life for terminally ill patients. Methods: Participants of this study were 114 terminally ill cancer patients who were diagnosed and died with stomach cancer and lung cancer at the K hospital of the C university. The study was a retrospective survey design that analyzed the medical costs for two weeks before they died. The cost analysis was done according to 11 items form the medical cost bill. Results: Patients enrolled in hospice care had significantly lower medical costs (53%) than did non-hospice patients especially in use of TPN, narcotic analgesics, nursing care, radiology tests, and blood tests. Among patients enrolled/admitted in the hospice unit, there was a significant cost difference only in use of analgesics whether the hospice specialized doctor was in charge of care or not. The cost was significantly lower when a hospice specialized doctor was in charge of care although the total medical cost was the same. Conclusion: This study identified lower medical costs for patients cared for in the hospice unit. Thus, we urge institutionalizing hospice care without delay to insure cost benefits as well as quality care.

• Journal of Hospice and Palliative Care
• /
• v.14 no.3
• /
• pp.144-151
• /
• 2011

Purpose: This study was conducted to compare nursing students' attitudes toward death, self-esteem and life satisfaction according to clinical experience. Methods: We surveyed 1,030 nursing students from two different universities with a questionnaire consisting of items regarding attitudes toward death, self-esteem and life satisfaction. The data were analyzed using a PASW program. Results: Students with clinical experience scored 2.85 on the attitude toward death, while those without clinical experience scored 2.79 (t=2.775, P=0.006). Students with clinical experience had significantly higher self-esteem (t=4.541, P<0.001) and life satisfaction (t=4.050, P<0.001) than those without it. Students with clinical experience showed correlations between attitude toward death and self-esteem (r=0.159, P<0.001) and life satisfaction (r=0.090, P=0.025), while those without it did not (r=0.106, P=0.014). Conclusion: These results provide guidance for developing educational strategies such as educational program to help students build positive attitude toward death through their experience in clinical practice.

• Journal of Hospice and Palliative Care
• /
• v.14 no.3
• /
• pp.163-171
• /
• 2011

Purpose: This study tested a model of hospice volunteer's motivations and outcomes to encourage more volunteer workers to participate in hospice care. Methods: This included 200 volunteers who attended the Autumn Conference in 2007 and 132 volunteers from five hospice organizations. Results: Volunteers' existential well-being affected an endogenous variable of volunteers' participation in volunteer activities. The durability of volunteer activity was affected by value motivation, the level of participation in volunteer activities and the level of job satisfaction. For volunteers' job satisfaction level, valid endogenous variables included existential well-being, social motivation, understanding motivation and value motivation. The durability of volunteer activities was indirectly affected through three different paths. Volunteers' existential well-being determined the level of their participation in volunteer activities, which in turn affected the durability of such activities. Social motivation influenced volunteers' job satisfaction, and then the durability of volunteer activities. Volunteers' understanding of motivation also influenced their job satisfaction, and then the durability of volunteer activities. Conclusion: Based on these results, this study proposes that the durability of volunteers activities could be improved by developing a program to improve volunteers' well-being and by providing volunteers with education on altruistic values, encouraging them to seek intellectual growth, and advocating them to continue volunteer activities based on close relationships with other volunteers.

• Journal of Hospice and Palliative Care
• /
• v.17 no.3
• /
• pp.122-133
• /
• 2014

Purpose: We conducted a descriptive correlational study to determine a relationship between nurses' awareness of good death and attitudes toward terminal care, which in turn could be used as basic data for improvement of the quality of terminal care at geriatric hospitals. Methods: From April 3, 2013 through April 22, 2013, data were collected from 230 nurses working at geriatric hospitals. Results: Nurses' attitudes toward terminal care showed no significant correlation with awareness of good death, but it was positively correlated with a sense of closeness, a subfactor of awareness of good death. There was negative correlation between emotions regarding a deathbed, a subfactor of attitudes of nurses in charge of terminal patients, and awareness of good death. We found positive correlation between terminal care performance and awareness of good death. Conclusion: This study warrants the need for nursing education catered to characteristics of geriatric hospitals and development of diverse intervention strategies to help them to attain a positive attitude toward death by familiarizing themselves with the concept of good death and enhancing job satisfaction.

• Journal of Hospice and Palliative Care
• /
• v.17 no.3
• /
• pp.151-160
• /
• 2014

Purpose: This study was conducted to investigate perception of good death among the community-dwelling elderly and identify factors related to the perception. Methods: A questionnaire survey was carried out using a convenient sampling method (N=317). Data were analyzed by applying descriptive statistics, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient, and stepwise multiple regression. Results: Participants scored an average of 3.35 on a 4-point scale for the perception level of good death. They scored higher on the factor of personal control that other factors affecting the perception. Good death was positively correlated with family support (r=0.252). Family support (${\beta}$=0.287) and gender (${\beta}$=0.197) significantly influenced the elderly's perception of good death. These variables accounted for 10.2% of the total variance. Conclusion: The results show that family support is an important factor for the perception of good death among the elderly. Therefore, family support should be carefully considered to ensure good death for more senior citizens. Our findings can be utilized to support programs such as death education for the elderly.

• Journal of Hospice and Palliative Care
• /
• v.17 no.3
• /
• pp.161-169
• /
• 2014

Purpose: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. Methods: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. Results: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". Conclusion: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.

• Journal of Hospice and Palliative Care
• /
• v.23 no.3
• /
• pp.103-113
• /
• 2020

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

• Radiation Oncology Journal
• /
• v.10 no.2
• /
• pp.261-266
• /
• 1992

We analyzed retrospectively the patients of granulocytic sarcoma treated with radiotherapy at the Department of Radiation Oncology, Yonsei University College of Medicine from Mar 1987 to Mar.1992 in an attempt to review our experience with irradiation of granulocytic sarcoma and to evaluate the treatment results for the radiation dose response. Fourteen lesions of granulocytic sarcoma in 9 patients were developed in variable clinical settings such as AML, CML and without leukemia. The involved lesions were bone, lymph node, soft tissue and skin in descending order of occurrence. All of the lesions in 9 patients were treated with external beam radiotherapy (Co-60 or electron beam). Both age distribution and clinical settings did not show any correlation with the response to treatment. The response to treatment seemed to be better for lesions in the bone than in other involved lesions. The majority received local irradiation of a total dose of more than 2000 cGy. Radiation dose of more than 2000 cGy showed excellent local control of $100\%$, (11/11), while local control decreased to $33\%$(1/3) with total dose less than 2000 cGy. In conclusion, local radiotherapy seems to be very effective for palliative or curative aim of granulocytic sarcoma, and a radiation dose more than 2000 cGy is highly recommended.