• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.39-46
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• 1998

Purpose : Hospice Care is considered as one of the most perfect solutions for the problems brought up as the number of chronically ill patients are increasing rapidly and most of social welfare oriented countries are seeking the quality of life. Our former studies(1996, 1997) were to find out the current status of the hospice care in Korea by surveying terminally ill patients and their family members as well as medical professionals. The former study was also to conduct the operation research by developing an information service system for training of hospice care teams and volunteers, and hospice patients management. The purpose of this study was that hospice information service system was tested by home visiting hospice care through visiting nurses. Methods : From October 1, 1997 to March 31, 1998, Twenty six terminal cancer patients were included in this study from Seoul National University Hospital and other hospital. Databases and homepage, hospice information service system were designed and developed for the information needed for the hospice care before this study by our research team and this services were available through the internet. Visiting nurses were trained about this system and they visited the patients with PC notebook and provided them hospice care with hospice information system. They collected physical, psychiatric, social data of the subjects at the first visit and during hospice care at home. Results : Sixteen subjects(61.5%) died during the study and the mean survival was 20.7 days. Anorexia(96.2%), immobility(88.5%) and pain(84.6%) were the major symptom in the 26 subjects, Altered nutrition(26.1%) and pain(12.4%) were the most frequent diagnoses in 226 nursing diagnoses of the subjects. Families understood and demanded the hospice care more than patients. And most patients and families didn't demand spiritual or social care. Conclusion : Through this demonstration study, it was found that we have to provide the information of pain management and nutritional support for patients by the nurses and visiting hospice nurse. The information service system needs to be upgraded with information and manpower of spiritual and social care according to the findings.

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.30-38
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• 1998

Background : Hepatocellular carcinomoma is the 3rd most common malignancy and the 2nd most common cause of death in Korea. The prediction of life-expectancy in terminal cancer patients is a major problem for patients, families, and physicians. We would like to investigate the prognostic factors of hepatocellular carcinoma, and therefore contribute to the prediction of the survival time of patients with hepatocellular carcinoma. Methods : A total of 91 patients(male 73, female 18) with hepatocellular carcinoma who were admitted to the hospital between January and lune 1995 were entered into the study, and data were collected prospectively on 28 clinical parameters through medical obligation record. We surveyed an obligation and local district office records, and confirmed the surivival of patients till July, 1996. Using Cox-proportional hazard model, give the significant variables related to survival. These determined prognostic factors. Life regressional analysis was used, there were calculated predicted survival day based on combinations of the significant prognostic factors. Results : 1) Out of 91 patients, 73 were male, and 18 were female. The mean age was $56.7{\pm}10.6$ ears. During the study, except for 16 patients who could not follow up, out of 75 patients, the number of deaths was 57(76%) and the number of survivals was 18(24%). 2) Out of the 28 clinical parameters, the prognostic factors related to reduced survival rate were prothrombin time<40%(relative risk:10.8), weight loss(RR:4.4), past history of hypertension (RR:3.2), ascites(RR:2.8), hypocalcemia(RR:2.5)(P<0.001). 3) Out of five factors, the survival day is 1.7 in all of five, $4.2{\sim}10.0$ in four, $10.4{\sim}41.9$ in three, $29.5{\sim}118.1$ in two, $124.0{\sim}296.6$ in one, 724.0 in none. Conclusion : In hepatocellular carcinoma we found that the prognostic factors related to reduce survival rate were prolonged prothrombin time(<40%), weight loss, past history of hypertension, ascites, and hypocalcemia(<8.7mg/dl). The five prognostic factors enabled the prediction of life-expectancy in patients with hepatocellular carcinoma and may assist in managing patients with hepatocellular carcinomal.

• Journal of Hospice and Palliative Care
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• v.3 no.2
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• pp.126-135
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• 2000

Purpose : To evaluate the present status of bereavement care in Korean hospice service as a basic database for the effective bereavement care. Method : The data were collected two sets from September to October, 1999 and from November to December, 2000, 55 hospice institutions identified by the Hospice Education Institution, College of Nursing, Catholic University were contacted for a telephone survey. The researchers conducted telephone interviews with hospice administrators for 10 to 30 minutes. Result : 1) Among the 55 Korean Hospice institutions, 38 institutions(69.1%) provided bereavement services. 2) The contents of bereavement services consisted of telephone call 28 institutions(74.5%), bereaved family meeting 26 institutions(69.4%), home visiting 22 institutions(57.9%), mail 16 institutions(42.1%), personal counselling 7 institutions(18.4%). 3) The 26 hospice institutions(68.4%) which provided meetings for bereaved families met with the following frequency : Annually is 11 institutions(42.3%), biannually 6 institutions(23.1%), monthly 6 institutions(23.1%) and bimonthly 3 institutions(11.5%). 4) Only 4 hospice institutions(10.5%) used the assessment tool to screen for high risk of bereaved. 5) The major difficulties of current bereavement services were low attendance for the bereaved family meeting, shortage of professional managers and volunteers, limited accessibility to hospice institutions, little social awareness for the bereaved, and financial difficulties. 6) The hospice administrators expressed the need for the development of bereavement program, the education program for the bereavement services, trained professionals, the sufficient provision of human resource and financial support for more effective bereavement services. Conclusion : Although many hospice institutions(69.1%) provided bereavement services, they generally lacked capable bereavement professionals and various individualized bereavement services. In conclusion, it is required to develop the specified bereavement program and the training program for the staff and volunteers, so as to provide customized bereavement services based on individual needs. Further research will be necessary to evaluate the effects of customized bereavement services in Korea before applying to practice.

• Journal of Hospice and Palliative Care
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• v.9 no.2
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• pp.101-105
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• 2006

Purpose: We aimed to investigate the efficacy and side effects of $Ultracet^{(R)}$ in relieving cancer pain in setting. Methods: Sixty-one cancer patients over 18 years old, who had cancer pain with or without medication, were enrolled. Pain and other variables were evaluated before and after treatment with $Ultracet^{(R)}$ for 2 weeks, using Korean version of Brief Pain Inventory. Results: Of 61 patients with assessable efficacy data, the maximum pain intensity(PI) experienced in a day were $5.18{\pm}1.41\;and\;4.82{\pm}1.94$, before and after treatment with$Ultracet^{(R)}$ respectively (P=0.113). The minimum PI experienced in a day were $1.2{\pm}1.05\;and\;0.87{\pm}1.35$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.038). The average PI experienced in a day were $3.61{\pm}1.01\;and\;3.15{\pm}1.73$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.022). The current PI were $3.63{\pm}1.25\;and\;2.85{\pm}1.94$, before and after treatment with $Ultracet^{(R)}$, respectively (P=0.003). Regarding the quality of life, only mood changed for the better in 49 patients who were treated with $Ultracet^{(R)}$ alone ($1.98{\pm}1.73\;and\;1.35{\pm}1.15$, before and after treatment respectively; P=0.046). There were five (8.2%) adverse events associated with $Ultracet^{(R)}$ treatment. Conclusion: $Ultracet^{(R)}$ seems effective and safe in ambulatory patients with cancer pain.

• Journal of Hospice and Palliative Care
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• v.9 no.2
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• pp.106-111
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• 2006

Purpose: In terminal cancer patients, pain control with narcotic analgesics and supportive care by hospice are very useful treatment modality. However, many patients and their caregivers are poorly compliant in using narcotic analgesics for fear of addiction and tolerance. And also many patients and family caregivers are reluctant to accept hospice, presuming that hospice means patient's condition is no longer reversible and progressively deteriorating. The purpose of this study was to evaluate and analyze the perception of using narcotic analgesics and hospice by family caregivers of terminal cancer patients who play a critical role in health care in Korean culture. Methods: A total of 54 terminal ranter patient's family caregivers participated in this study. Questionnaire consisted of 15 questions about narcotic analgesics and hospice. Results: The study revealed following results. 1) family caregivers who are not aware of hospice are more than half (56.7%). 2) 81.8% of family caregivers agreed that hospice care is beneficial to terminal cancer patients. 3) 85.1% of family caregivers were under financial burden. 4) 83.2% of patient complained pain in 24 hours. 3) while 88.5% of family caregivers believed that narcotic analgesics can control pair, 79.1% and 79.6% of them also believed that use of narcotic analgesics would result in addiction and tolerance, respectively. Conclusion: There still exist barriers to family caregivers in using narcotic analgesics for pain control. And also, terminal cancer patient's family caregivers have poor information about hospice. Therefore, educational intervention about narcotic analgesics by pharmacist and doctors are needed for proper pain control for terminal ranter patients. In addition, more precise information about hospice care should be provided for terminal cancer patients and their family caregivers.

• Journal of Hospice and Palliative Care
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• v.11 no.4
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• pp.188-195
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• 2008

Purpose: The purpose of this study was to analyze the effects of aromatherapy on stress using meta-analysis. Methods: Meta-analysis was done with 21 published studies, and data were analyzed with the SAS 9.1 program. Results: Fifty eight effect size was estimated with data from 21 published studies. Overall mean effect size (ES), and mean effect size of dependence variables according to the type of intervention and subject and according to the total amount of time spent in aromatherapy were estimated. Overall mean effect size of the effects of aromatherapy was .593, and the subjective stress (.983) was most effective in the physiological faculty, followed by mean effect size of cortisol (.648) and pulse (.40). On the other hand, mean effect size of systolic blood pressure (.490) was moderate, and that of diastolic blood pressure (.401) was not large. Mean effect size of elderly (.706) cancer patients was considerable(.337). There were significant differences depending on the subjects. With regards to the types of aromatherapy, the effect size of aroma massage combined with inhalation therapy was .590, and there were no significant differences between the intervention methods. With regards to the time of intervention, $20{\sim}30$ minutes spent in aromatherapy was .730, and there were no significant differences between the times of intervention. The relationship between the effect size and intervention frequency was r=.349 and showed significant difference. Conclusion: This result suggests that aromatherapy is an effective intervention to reduce stress for subjects. Nursing intervention protocol by using aromatherapy should be developed and applied in clinical and community settings. Further studies on the effects of aromatherapy on stress should be done by using meta-analysis.

• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.24-31
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• 2010

Purpose: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. Methods: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. Results: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). Conclusion: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.

• Journal of Hospice and Palliative Care
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• v.6 no.2
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• pp.172-176
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• 2003

Purpose : This study was designed to evaluate the perception of cancer in the students of Korea University. Methods : 1,000 students of Korea University were surveyed by questionnaire from March 2001 to September 2002. Nine hundred ninety two complete questionnaires were returned. The data were analyzed by descriptive statistics, and Chi-square analysis using the SPSS program. Results : 701 students (76.1%) replied that cancer is a curable disease. However, the degree of satisfaction for cancer treatment with modem clinical medicine was low (37.5%). Moreover, they thought that there was no difference between the efficacy of treatment by chemotherapy, alternative medicine, or dietary modification. But, the positive evaluation for the effectiveness of chemotherapy in the students who had cancer patients in their families was higher than that in the students without the experience of cancer patients in their families. Six hundred ninety four students (75.3%) replied positively for euthanasia in terminal cancer patients. And they thought that the dignity and the right of the patients were the most important point that should be considered in making the decision of euthanasia. Conclusions : The credibility to modem clinical medicine for cancer treatment was relatively low in the students of Korea University who had no cancer patients in their families. So, further studies and trials will be warranted to evaluate the causes of these results and improve the credibility of modem clinical medicine for cancer treatment in the general population.

• Journal of Hospice and Palliative Care
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• v.2 no.2
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• pp.91-100
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• 1999

Purpose : This study was performed to investigate the satisfaction in the hospice services provided for inpatient families and bereaved families whose members had been admitted to the hospice unit at Kangnam St. Mary's Hospital to improve the quality of care for the terminally ill patients and their families. Methods : This sample consisted of 33 families of hospice patients during the period of April to lune, 1998 and 30 bereaved families whose patients had died from March, 1993 to March, 1998. The data were collected through a self-report questionnaire and analyzed using t-test and ANOVA. Results : 1) The satisfaction level of inpatient families and bereaved families showed the mean value of 3.5 where the highest value is 5.0. 2) According to age, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family, medical management and nursing management(P=0.0001). The level of satisfaction of bereaved families showed significant differences in the field of support for the family, medical management, nursing management, and facilities of the hospice unit(P=0.0001). 3) By family relationship, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family, medical management and nursing management (P=0.0001). 4) According to religion, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family and nursing management (P=0.0001), but there was no significant difference for the bereaved families. Conclusions : The findings of this study showed that hospice services had positive influence on families with terminal disease such as cancer. To improve the level of satisfaction in the hospice services for families with hospice patients, we need to provide care by an interdisciplinary hospice team approach, and to assess needs of the families according to their socio-psychological characteristics. Further studies need to be conducted with large samples.

• Journal of Hospice and Palliative Care
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• v.2 no.2
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• pp.114-124
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• 1999

Purpose : To clarify the relation between psychosocial variables and cancer in Korea. Methods : Case-control study. Participants: 239 subjects in 2 university hospitals in Seoul completed a series of psychometric instruments(the Olson's FACES III and the Lee's 98-items life event scale). Results : In bivariable analysis, there were statistically significant difference in age and economic status(income): marginal significance in education status and marital status between the cases and controls. The family function type and stress score were not significantly different. The result of multivariable logistic regression, analysis showed that the risk of cancer was associated with economic status and marital status, but neither the family function nor the life event stress. Conclusion : In this study, we cannot prove the statistical association between the family function, life event stress and cancer. It is necessary to persevere in our efforts to clarify the relation between stress and disease and to develop the useful tools to measure the Korean family function and life event stress.