• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.71-84
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• 2020

Purpose: The purpose of this systematic review and meta-analysis was to investigate the effects of advance care planning on end-of-life decision-making. Methods: Databases including RISS, KISS, KMbase, KoreaMed, PubMed (MEDLINE), Embase, and CINAHL were searched for studies that examined the effects of advance care planning interventions. The inclusion criteria were original studies in English or Korean; adults ≥18 years of age (population); advance care planning (intervention); completion of advance directives (AD) or advance care planning (ACP) (outcomes); and randomized or non-randomized controlled trials (RCTs and non-RCTs, respectively) (design). Study quality was measured using the checklists of the Joanna Briggs Institute. Meta-analyses were conducted with the Comprehensive Meta-Analysis program. Results: Nine RCTs and nine non-RCTs were selected for the final analysis. The effect sizes (ES) of the outcome variables in nine RCTs were meta-analyzed, and found to range from 0.142 to 0.496 for the completion of AD and ACP (ES=0.496, 95% CI: 0.157~0.836), discussion of end-of-life care (ES=0.429, 95% CI: -0.027~0.885), quality of communication (ES=0.413, 95% CI: 0.008~0.818), decisional conflict (ES=0.349, 95% CI: -0.059~0.758), and congruence between preferences for care and delivered care (ES=0.142, 95% CI: -0.267~0.552). Conclusion: ACP interventions had a positive effect on the completion of AD and ACP. To apply AD or ACP in Korea, it is necessary to develop ACP interventions that reflect aspects of Korean culture.

• Journal of Hospice and Palliative Care
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• 제23권1호
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• pp.27-38
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• 2020

Purpose: The purpose of this study was to compare differences in spiritual needs (SNs) and factors influencing SNs between patients with progressive terminal kidney disease and their family caregivers. Methods: An explorative comparative survey was used to identify the SNs of patients (N=102) with progressive terminal kidney disease undergoing hemodialysis and their family caregivers (N=88) at a general hospital located in Seoul, South Korea. The data were analyzed using descriptive statistics, the chi-square test, the independent t-test, one way analysis of variance, the Scheffe test, and multiple regression with dummy variables. Results: The SNs among family caregivers were higher than in the patient group. SNs were higher among those who were religious in both groups. Loving others was the highest-ranked subdimension in the patient group, followed in descending order by maintaining positive perspective, finding meaning, Reevaluating beliefs and life, asking "why?", receiving love and spiritual support, preparing for death, and relating to God. In the family group, the corresponding order was maintaining positive perspective, loving others, finding meaning, receiving love and spiritual support, preparing for death, relating to God, and asking "why?". The factors that had a negative influence on the level of SNs were not being religious in the patient group and having only a middle school level of education in the family group. Conclusion: The results of this study may serve as evidence that spiritual care for non-cancer patients' family caregivers should be considered as an important part of hospice and palliative care.

• Journal of Hospice and Palliative Care
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• 제23권1호
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• pp.17-26
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• 2020

Purpose: This study was conducted to develop a hospice music therapist training program and to evaluate its effects. Methods: The educational program consisted of training on the theory of hospice and the theory and practice of hospice music therapy. The course lasted for 4 weeks, with 8 hours of training per week, and 33 music therapists completed the course. In order to assess the effectiveness of the course, participants' knowledge and confidence regarding hospice music therapy and readiness for hospice music therapy before and after education were measured. The statistical analysis was done using SPSS version 18.0 and the paired t-test was used to assess the effectiveness of the program. Results: The trainees showed significant improvements in knowledge (P<0.001) and confidence (P<0.001) in all areas of this course, as well as in readiness for hospice music therapy (P<0.001). Participants' satisfaction with the lectures was assessed using a 5-point Likert scale. The average score for all lecture areas exceeded 4 (yes), and the satisfaction level was mostly high. Students were most satisfied with the lectures on music therapy theory, followed in order by those on music therapy practice and hospice theory. Conclusion: This hospice music therapist training program is considered to be suitable because of its positive educational effects and the high satisfaction of participants with the lectures. In order to provide high-quality music therapy services to patients and their families, this training course should be regularly offered to cultivate competent music therapists, and the content of the education should be standardized and applied in various clinical settings.

• Journal of Hospice and Palliative Care
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• 제23권1호
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• pp.11-16
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• 2020

Purpose: D-dimer levels are known to be associated with poor outcomes in patients with various cancers, but their significance at the end of life remains unclear. This study investigated D-dimer levels as a prognostic indicator for terminal cancer patients in the last hours of life. Methods: The retrospective study was conducted at a palliative care unit of a tertiary cancer center, using a database to analyze the records of patients treated from January 1, 2010 to December 31, 2018. In total, 67 terminal cancer patients with available data on D-dimer levels were included. Patients' demographic data, clinical information, and laboratory values, including D-dimer levels, were collected. Survival was analyzed using the Kaplan-Meier method and the log-rank test. A Cox proportional-hazards model was used to identify prognostic factors of poor survival. Results: The most common site of cancer was the lung (32.8%) and the median survival time was 5 days. Most laboratory results, particularly D-dimer levels, deviated from the normal range. Patients with high D-dimer levels had a significantly shorter survival time than those with low D-dimer levels (4 days vs. 7 days; P=0.012). In the Cox regression analysis, only a high D-dimer level was identified as a predictor of a poor prognosis (hazard ratio, 1.83; 95% confidence interval, 1.09~3.07). Conclusion: Our results suggest that at the very end of life, D-dimer levels may serve as a prognostic factor for survival in cancer patients.

• 호스피스학술지
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• 제7권2호
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• pp.6-14
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• 2007

Purpose: Hepatocellular carcinoma is the 3rd leading cause of cancer death in Korea and its prognosis is very poor. We aimed to investigate the clinical characteristics of terminal patients with hepatocellular carcinoma on admission into a hospice unit, and to know if they had received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 62 patients with hepatocellular carcinoma who had admitted, received palliative care, and died in a hospice unit between January 2003 and December 2005. Results: The median age of patients was 56.5 years with 50 men(80.65%) and 12 women(19.35%) and gender ratio(male to female) was 417. Child-Pugh class A, B, and C were 6(9.68%), 22(35.38%), and 34(58.84%) respectively. We divided the patients into two groups and compared, the terminal HCC patients with class C as group I and those with class A & B as group 2. The median time from hospice referral to death was significantly short in group 1 with 15.5 days compared to group 2 with 53 days. Statistically more prevalent symptoms in group I were ascites, dyspnea, peripheral edema, and hepatic encephalopathy with abnormal laboratory findings (jaundice, hypoalbuminemia, or renal insufficiency). There, however, was no significant difference in complications and managements during admission between group 1 and 2. Conclusion: Most terminal HCC patients were often accompanied with chronic liver disease. The length of hospice and palliative care for above patients was not enough to attend them. Therefore, we suggest that proper education and information should be provided to physicians, patients, and their family members for effective hospice and palliative care.

• 디지털융복합연구
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• 제13권1호
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• pp.67-76
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• 2015

본 연구의 목적은 독거노인의 욕구를 지원하기 위한 ICT기반 독거노인복지서비스의 역할을 정립하는 것이다. 독거노인은 고령화가 가속됨에 따라 2010년 102만 가구로 증가 추세이며 정신적, 사회적, 경제적인 어려움 등으로 인해 사회문제로 대두되었다. 본 연구는 기존 시행된 6개 부처의 85개 노인복지서비스와 향후 제공가능 한 114개 ICT기반 복지서비스를 조사하였다. 이들 서비스를 Maslow의 욕구분류체계에 따라 유형화하고 오프라인, 온라인, 온오프라인병행 서비스로 구분하였다. 연구의 결과는 안전욕구(의료 건강), 자아실현욕구(여가 문화) 서비스에 집중되어 있고 자존욕구 서비스는 저조한 것으로 나타났다. ICT기반 노인복지서비스를 통해 환경개선, 일자리 확대, 독립적인 일상생활지원 서비스는 개선이 가능하고 심리/정서지원 서비스 등은 추가 발굴이 필요하다는 것을 알 수 있었다. 본 연구결과로 현재 제공되는 서비스의 편중은 완화하고 부재는 보완하는 등 ICT기반 수요자 중심 노인복지서비스를 통해 독거노인의 삶의 질을 향상시킬 수 있을 것이다.

• Journal of Hospice and Palliative Care
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• 제17권1호
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• pp.1-9
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• 2014

목적: 본 연구는 암환자 가족돌봄자의 외상 후 성장수준과 이에 관련된 인구사회학적 및 돌봄관련 특성들을 심층 분석하여 암환자 가족돌봄자의 간호중재 모색에 활용하고자 시도되었다. 방법: 연구의 대상은 부산광역시에 소재하는 두 개의 종합병원과 일개의 대학병원에서 입원 및 외래 치료를 받고 있는 201명의 암환자의 가족돌봄자이다. 외상 후 성장은 한국판 외상 후 성장 척도(Korean posttraumatic growth inventory, K-PTGI)로 측정하였다. 수집된 자료는 IBM SPSS Statistics 21 프로그램을 이용하여 서술통계, t-test, one-way ANOVA, Scheffe's test로 분석하였다. 결과: 대상자의 외상 후 성장 점수 평균은 3.10점이었다. 하위 요인별로는 자기 지각의 변화, 대인관계의 깊이 증가, 새로운 가능성의 발견, 영적 종교적 관심의 증가 순이었다. 대상자들의 인구사회학적 특성과 돌봄 관련 특성에 따른 외상 후 성장 수준의 차이는 나이, 종교, 종교생활의 중요성, 돌봄으로 인한 일상생활의 어려움 정도에 따라 차이가 있었다. 결론: 암환자에 대한 질적인 간호를 제공함에 있어 환자뿐 아니라 가족돌봄자들도 포함해야 한다. 또한 암환자 가족돌봄자가 환자의 암 투병 경험에서 궁극적인 성장에 도달할 수 있도록 자신들의 영적 종교적 신념을 유지할 수 있는 영적 간호중재 개발이 필요하다고 본다.

• 한국산학기술학회논문지
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• 제20권10호
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• pp.395-405
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• 2019

우리나라는 경제발전, 출산율 저하, 보건의료의 발달로 65세 이상 노인 인구의 비율이 2018년 14% 고령사회, 2026년 20% 초고령사회로 예상되어 빠른 인구구조의 변화를 겪고 있다. 고령화에 따라 치매, 중풍 등 일상생활이 어려운 노인들의 수는 날로 증가하고, 핵가족화, 여성의 사회참여 증가 등으로 장기요양이 필요한 노인들을 가정에서 돌보는 것이 어려워졌다. 이에 정부는 이러한 사회적 구조 및 노인문제를 해결하기 위해 장기요양대상 노인의 삶의 질 향상과 가족부양 부담의 완화 등을 목적으로 노인장기요양보험법을 제정하여 시행하고 있다. 따라서 본 연구는 시설의 민영화와 난립으로 서비스의 공적 책임과 시설의 질 제고에 대한 요청이 확산되고 있는 부분을 살펴보고자 한다. 이 밖에도 저임금 요양인력의 양산, 재원조달 방식에 관한 문제 등의 대비가 다각도로 부족한 부분을 도출하고자 하였다. 본 연구를 통하여 노인장기요양보험제도가 초고령화 사회를 대비하여 장기 지속적으로 유지 발전하기 위해서는 법 제도적 측면의 개선방안의 모색과 더불어 노인복지서비스가 신체적 건강 뿐만 아니라 노후 생활의 안정을 위한 정신적 심리적 조치를 강구하는 방안을 검토하고자 한다.

• Journal of Hospice and Palliative Care
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• 제24권3호
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• pp.174-183
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• 2021

Purpose: This study aimed to investigate the effects of the nursing practice environment and self-leadership on person-centered care provided by oncology nurses. Methods: This cross-sectional study included 145 nurses who worked in oncology wards at eight university hospitals in Seoul, Daejeon, and Chungcheong Province with at least six months of experience. Data were collected using a self-administered survey and analyzed using descriptive statistics, Pearson correlation coefficients, the t-test, analysis of variance, and hierarchical multiple regression analysis in SPSS version 26.0. Results: Person-centered care was significantly correlated with the nursing practice environment (r=0.27, P<0.001) and self-leadership (r=0.40, P<0.001), and the nursing practice environment was correlated with self-leadership (r=0.380, P<0.001). Hierarchical multiple regression analysis showed that the nursing practice environment was a significant predictor of person-centered care (β=0.31, P<0.001), after adjusting for covariates including monthly salary, total clinical career, and the position of oncology nurses. Self-leadership was a significant predictor of person-centered care (β=0.34, P<0.001) after controlling for the nursing practice environment, along with covariates. The final model explained 18.7% of the variance in personcentered care. Conclusion: Our findings emphasize the importance of the nursing practice environment and nurses' self-leadership for providing person-centered care in oncology care units. Educational programs to reinforce nurses' self-leadership and administrative support for nursing practice are necessary to improve oncology nurses' capability to provide person-centered care.

• 인간행동과 음악연구
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• 제15권2호
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• pp.41-67
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• 2018

본 연구는 지지적 심리치료의 치료적 접근 방식인 내적 자원 확립을 중심으로 한 지지적 노래만들기 프로그램이 학교 부적응 청소년의 적응유연성을 향상시키는지 알아보기 위한 사례연구이다. 4명의 학교 부적응 중학생을 대상으로 총 8회기의 지지적 노래만들기 프로그램이 회기 당 50분씩 진행되었으며, 대상자들은 회기별 목표에 따라 현재 심리적 적응 문제에 대해 가사를 만들고 완성된 노래를 가창 및 토의하는 활동에 참여하였다. 결과 분석을 위해 사전 사후 적응유연성 척도 검사를 실시하고 4개 하위요인별 점수 변화를 평가했으며, 참여자들의 가사를 분석하여 적응유연성 하위요인과 관련된 내용이 어떻게 반영되었는지 살펴보았다. 연구 결과 모든 참여자들의 적응유연성 점수가 증가했으며, 가사 분석 결과 참여자 4명 모두 각자의 가사에 표현한 현재 적응 문제의 하위요인과 관련하여 가장 큰 변화를 보였다. 결과적으로 지지적 노래만들기 프로그램에 참여한 학교 부적응 청소년 모두는 적응유연성 향상을 나타냈다. 이러한 연구 결과는 노래를 만드는 과정이 학교 부적응 청소년의 심리적 적응 문제와 내적 자원을 다루어 문제를 바라보는 시각 변화를 유도하였으며, 이를 통해 학교적응을 위한 적응유연성을 향상시키는 데 기여할 수 있음을 시사한다.