• Journal of Hospice and Palliative Care
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• 제24권1호
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• pp.66-68
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• 2021

The World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak to be a pandemic on March 12, 2020. In Korea, there have been 24,027 confirmed cases of COVID-19 and 420 deaths as of October 3, 2020. The clinical spectrum of COVID-19 ranges from asymptomatic infection to death. Cancer care in this pandemic has radically changed. The literature was reviewed. The COVID-19 pandemic has made it urgently necessary to profoundly re-organize cancer patients' care without compromising cancer outcomes. Several important questions in regard to COVID-19 infection in cancer patients have emerged. Are patients with cancer at a higher risk of COVID-19 infection? Are they at an increased risk of mortality and severe illness when infected with COVID-19? Does anticancer treatment affect the course of COVID-19? Based on the existing research, cancer patients with immunosuppression are vulnerable to COVID-19 infection, and cancer patients are more likely to experience severe COVID-19. However, chemotherapy and major surgery do not seem to be predictors of hospitalization or severe disease. Korean background data on patients with cancer and COVID-19 are lacking. Prospective multicenter studies on the outcomes of patients with cancer and COVID-19 should be conducted.

• Journal of Hospice and Palliative Care
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• 제24권1호
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• pp.26-35
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• 2021

Purpose: The purpose of this study was to determine the effects of awareness of good death and end-of-life care attitudes on end-of-life care performance in long-term care hospital nurses. Methods: This study used a cross-sectional study design. The participants were 147 nurses working at six long-term care hospitals with more than 200 beds in B city, South Korea. Data were collected using self-reported questionnaires, and analyzed with descriptive statistics, the t-test, analysis of variance, Pearson correlation coefficients, and multiple stepwise regression analysis using IBM/SPSS 26.0 for Windows. Results: The participants' awareness of good death, end-of-life care attitudes, and end-of-life care performance were positively correlated. The factors affecting end-of-life care performance were age, education level, awareness of good death, and end-of-life care attitudes; these variables explained 19.0% of end-of-life care performance. Conclusion: In order to improve long term care hospital nurses' end-of-life care performance, continuing education and training should be provided regarding awareness of good death and end-of-life care attitudes.

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.198-211
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• 2020

Purpose: The purpose of this study was to examine the relationships of knowledge, attitudes, and self-efficacy related to palliative care among health care providers (doctors and nurses) in order to provide a basis to develop a training program for health care providers. Methods: A correlational and descriptive study design was used. Participants were recruited from a university-affiliated hospital located in Daejeon and an e-nurse community. After IRB approval, data were collected from July 12, 2018, to September 30, 2018. A total of 169 responses were finally analyzed using version SPSS 24. The data were analyzed in terms of descriptive statistics (frequency and percentage or mean and standard deviation, as appropriate), the t-test, analysis of variance (with the Duncan post hoc test), and Pearson correlation coefficients. Results: Knowledge, attitudes, and self-efficacy were significantly higher in those who had received palliative care training or had been exposed to awareness-raising initiatives. There were positive relationships among knowledge, attitudes, and self-efficacy, with small to moderate effect sizes. Conclusion: Palliative care training for health care professionals is necessary to meet patients' needs. Such programs should take into account not only knowledge about palliative care, but also ways to improve empathy and resolve ethical dilemmas. Interprofessional training would be an excellent option to share therapeutic goals and develop communication skills among multidisciplinary team members.

• Journal of Hospice and Palliative Care
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• 제24권1호
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• pp.46-55
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• 2021

Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Results: Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. Conclusion: The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.42-49
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• 2022

As population aging increases the burden of cancer, the quality of death of patients with cancer is emerging as an important issue alongside their quality of life. To improve the quality of death, it is necessary to prepare for death, allowing patients to die comfortably and with dignity at the end. Considering these issues, I aim to discuss the practical aspects of notifying the patient of the terminal phase of cancer and planning for end-of-life care (i.e., advance care planning). When cancer treatment that can extend the patent's lifespan becomes difficult, the patient enters a treatment transition period. Treatment is shifted from life-prolonging care to life-enhancing care, and end-of-life care must be well planned. Medical providers often worry too much about whether the patient will be disappointed or psychologically traumatized when notified of the terminal phase of their cancer, thus delaying plans for end-of-life care. In fact, patients can accept their condition and prepare for end-of-life care better than we expect. During the treatment transition period, notification of terminal status should be given, and a well-prepared advance care plan should be established early when the patient has decision-making ability. In addition to conveying information, it is always necessary to be sensitive to whether the patient and caregiver understand the information and respond to their emotions.

• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.50-54
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• 2022

Antibiotics are commonly prescribed medications in the hospice and palliative care setting, as well as in many other healthcare settings. The overuse or negligent use of antibiotics is associated with the harmful consequence of fostering the development of antibiotic-resistant pathogens. Thus, there is an urgent need to critically examine and audit antibiotic use in all aspects of healthcare. In the status quo, there is a lack of consistent standards and guidelines surrounding the use of antibiotics in hospice and palliative care settings, leading to significant variations in how antibiotics are prescribed and administered in end-of-life care. It is apparent that greater thought needs to go into antibiotic decisions for patients receiving hospice or palliative care, especially considering the harmful consequences of the overprescription of antibiotics. The literature suggests that many clinicians prescribe antibiotics inappropriately for patients who would not benefit from their use or prescribe them without adequate documentation. Clinicians should be deliberate about when they prescribe antibiotics and adhere to the appropriate documentation standards and procedures within their institution or community. Future research should seek to generate generalizable knowledge about which patients will benefit most from antibiotic therapy during end-of-life care.

• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.254-260
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• 2021

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

• Journal of Hospice and Palliative Care
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• 제25권3호
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• pp.99-109
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• 2022

Purpose: More than 60% of patients with advanced cancer experience pain, and uncontrolled pain reduces the quality of life. Nurses are the closest healthcare providers to the patient and are suitable for managing cancer pain using pharmacological and non-pharmacological interventions. This study aimed to identify factors affecting the performance of cancer pain management among nurses. Methods: This study was conducted among 155 participating nurses working at a tertiary hospital who had experience with cancer pain management. Data collection was performed between October 18, 2021 and October 25, 2021. Data analysis was conducted using descriptive statistics, the independent-sample t-test, one-way analysis of variance, and hierarchical regression analysis. Results: There were 110 subjects (71.0%) who had no experience of cancer pain management education. The results of regression analysis indicated that barriers included medical staff, patients, and the hospital system for cancer pain management (𝛽=0.28, P<0.001). The performance of cancer pain management was also affected by experience of cancer pain management training (𝛽=0.22, P=0.007), and cancer pain management knowledge (𝛽=0.21, P=0.006). The explanatory power of the variable was 16.6%. Conclusion: It is crucial to assess system-related obstacles, as well as patients and medical staff, in order to improve nurses' cancer pain management performance. A systematic approach incorporating multidisciplinary interventions from interprofessional teams is required for effective pain management. Furthermore, pain management education is required both for cancer ward nurses and nurses in other wards.

• Journal of Hospice and Palliative Care
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• 제25권4호
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• pp.169-177
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• 2022

Purpose: The aim of this study was to examine the influence of spirituality and job satisfaction on the compassion competence of hospice nurses. Methods: This was a cross-sectional study of 118 hospice nurses from 16 hospitals in Daejeon, Chungcheong Province, and Jeolla Province. A self-administered survey was conducted using a structured questionnaire including the Spirituality Scale, Index of Work Satisfaction, the Compassion Competence Scale for Nurses, and general socio-demographic information. The data were analyzed using descriptive statistics, the t-test, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows version 26.0. Results: Compassion competence was correlated with spirituality (r=0.66, P＜0.001) and job satisfaction (r=0.52, P＜0.001), and spirituality was correlated with job satisfaction (r=0.44, P＜0.001). Spirituality (β=0.513, P＜0.001) and job satisfaction (β=0.273, P＜0.001) were significant factors affecting the compassion competence of hospice nurses, after adjusting for the sociodemographic and work-related covariates. The step-by-step results from hierarchical linear regression analysis also indicated that spirituality had a stronger impact than job satisfaction on compassion competence. Conclusion: Our findings demonstrate the importance of spirituality, which plays a role in guiding the compassion competence of hospice nurses. It is necessary to support the spirituality and job satisfaction of hospice nurses, which could facilitate their compassion competence and thereby contribute to improving the quality of hospice and palliative care.

• Journal of Hospice and Palliative Care
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• 제25권4호
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• pp.159-168
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• 2022

Purpose: This study aimed to investigate the impacts of end-of-life care competency and ethical dilemmas on psychological burnout in nurses who care for terminal cancer patients. Methods: A cross-sectional study of 160 nurses who cared for terminal cancer patients was conducted. The participants were recruited from the hospice-palliative care wards, hematology or oncology wards, or intensive care units of three general hospitals in a single metropolitan area. Data were collected using a self-administered survey to assess end-oflife care competency, ethical dilemmas, psychological burnout, and general sociodemographic characteristics. Data were analyzed using descriptive statistics, the independent ttest, analysis of variance, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows (version 26.0). Results: Psychological burnout was significantly correlated with end-of-life care competency (r=-0.23, P=0.003) but not with ethical dilemmas. The results of the hierarchical linear regression analysis indicated that endof-life care competency (β=-0.280, P=0.010) and ethical dilemmas (β=0.275, P=0.037) were significant predictors of psychological burnout, after adjusting for age, religious status, clinical experience, and unit type. Conclusion: The current study's findings demonstrate that end-of-life care competency and ethical dilemmas are crucial factors that affect psychological burnout in nurses who care for terminal cancer patients. Substantive education programs must be developed to improve nurses' competencies in end-of-life care and ethical dilemmas to decrease psychological burnout.