• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.189-199
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• 2004

Purpose: Despite the small incidence, head and neck cancer may cause a wide range of physical transformation by surgical operation, damage to active functions such as eating and speaking. It may provoke hopelessness, change self-esteem and self-concept after its operation, influencing the quality life of head and neck cancer patients. Thus nursing intervention should be developed to provide supportive nursing for head and neck cancer patients and play roles as competent supporters. Methods: This study was a nonequivalent, control group, pretest-posttest, non-synchronized quasi-experimental research designed to determine how supportive nursing intervention effects on hopelessness, self-esteem and self-concept of head and neck cancer patients. Subjects of the study included 40 adult inpatients of K University hospital in Pusan who were diagnosed as having head and neck cancer and operated. They were divided into experimental and comparison groups, each consisting of 20 members. The data were collected during the period from December 1, 1999 to April 11, 2000. Tools of the study included the protocol of supportive nursing intervention which was developed by researcher by means of reference, literal review and expert's advice. The measurement tool of hopelessness was translated by Won was the device of hopelessness self-evaluation from Beck, the tool for self-esteem measurement was developed by Rosenberg and translated by Kim, and the device of self-concept used by Lee et al, modified by Lee were used respectively. Data were analyzed using the SPSS/PC 9.0 program. The homogeneity of the subjects were tested using $x^2-test$ and t-test. 3 hypotheses were tested using t-test. Results: The results of the study can be summarized as follows. 1. The third hypothesis that the experimental group receiving supportive nursing intervention showed a little hopelessness than the control group not receiving supportive nursing intervention was supported (t=4.550, P=.000). 2. The third hypothesis that the experimental group receiving supportive nursing intervention showed more self-esteem than the control group not receiving supportive nursing intervention was supported (t=-6.40, p=.000). 3. The third hypothesis that the experimental group receiving supportive nursing intervention showed more self-concept than the control group not receiving supportive nursing intervention was supported (t=-6.065, P=.000). Conclusion: Supportive nursing intervention was effective nursing intervention strategy for reducing hopelessness and increasing self-esteem and self-concept of head and neck cancer patients. Then the quality of life of head and neck cancer patients can be enhanced by providing supportive nursing intervention in nursing practice.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.169-178
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• 2004

Purpose: The aim of the study was to assess changes of the attitudes and opinions about disclosure of cancer diagnosis to patients. Methods: We analyzed the attitudes and opinions of in-patients with metastatic cancer, their families, physicians, nurses, medical students, nursing students. Three questionnaires were used for in-patients, families, and surroundings in hospital. Data was collected in the St. Mary hospital for 3 months from October, 2002. We investigated the preference of disclosure, the reason the patients should be informed of disclosure, when, how and who to tell the cancer diagnosis to patients. 242 persons participated in these questionnaires (50 in-patients, 50 their families, 51 physicians and nurses, 41 medical students, 50 nursing students). Only 34 in-patients with metastatic cancer were enrolled, and so 16 in-patients with lymphoma were added. All in-patients were undergoing anticancer chemotherapy. Results: 89.3% of the participants wanted to be told about disclosure of cancer and terminal illness (in-patients 98.0%, their families 88.0%, physicians and nurses 90.2%, medical students 73.2%, nursing students 94.0%, in-patients with metastatic cancer 97.1%). 79.8% of the respondents hoped that the moment to tell the truth was immediately when the disease was diagnosed (in-patients 94.0%, their families 80.0%, physicians and nurses 68.6%, medical students 68.3%, nursing students 86.0%). 64.4% of all prefered to be told the truth once for alt including patients' diagnosis, present status and prognosis (in-patients 81.6%, their families 66.0%, physicians and nurses 56.0%, medical students 48.8%, nursing students 70.0%). Most indicated the first reason to be told the truth was the possibility to participate in treatment design. 86.4% responded that physicians were the proper persons to disclose the diagnosis. Conclusion: Not only in-patients, families but also physicians, nurses, medical students and nursing students all preferred the disclosure of cancer diagnosis. This preference was increased compared with the previous papers. The first reason to be told the truth was the possibility to participate in treatment design. Most of the participants wanted to be told the truth once for all.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.214-220
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• 2004

Purpose: As for the malignant bowel obstruction of terminal cancer patient, a prognosis is relatively bad. Physicians consider palliative procedures or surgery for the quality of life, but sometimes it is hard to decide. After diagnosis of a malignant bowel obstruction in terminal cancer patients, we investigated the clinical characteristics, the prognostic factors and the survival of patients with palliative procedures or surgery. Methods: we retrospectively reviewed the medical records in 40 malignant bowel obstruction patients who had been diagnosed as terminal cancer from May in 2002 to May in 2004. Results: There were 21 males (53%) and 19 females (47%), and median age of patients was $64.1{\pm}1.58$ years. The most common cause of malignant bowel obstruction was colorectal cancer (18 patients, 45%), followed by stomach cancer (11, 28%), pancreatic cancer (4, 10%), others (7, 19%). Metastases were carcinomatosis peritonei (14 patients, 35%), liver (13, 33%). During a bowel obstruction, symptoms were vomiting (15 patients, 38%), abdominal pain (10, 25%), constipation (6, 15%), abdominal distension (5, 13%). Performance status (ECOG) was 2 score (16 patients, 40%), 3 score (20, 50%), 4 score (4, 10%). Palliative procedure group were 30 patients, the others 10. Median survival in palliative procedure group was 142 days, that of no palliation group 30. Median survival time of palliative procedure group from palliative procedures or surgery were significantly higher than that of no palliation group from diagnosis of malignant bowel obstruction. Prognostic factors of palliative procedure group were PS, site of obstruction and primary cancer. Median survival in PS 2, lower GI obstruction and colorectal cancer was higher than PS 3, upper GI obstruction and others, respectively. Conclusion: we recommend aggressively palliative procedures or surgery in malignant bowel obstruction patients diagnosed with terminal cancer if palliative procedures or surgery could be performed effectively.

• Journal of Hospice and Palliative Care
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• v.15 no.2
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• pp.68-76
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• 2012

Purpose: The study was designed to verify effects of aromatherapy on depression, anxiety and the autonomic nervous system in breast cancer patients who are undergoing adjuvant radiotherapy. Methods: Data were collected from November 2006 through March 2007 at the C university hospital in Seoul. The study included 33 patients and they were assigned to three groups. Group I had aroma oil inhalation for 2 minutes per time, three times a day for six weeks whereas Group II and a control group inhaled aroma oil for 2 minutes per time, once a day for six weeks. For Groups I and II, a mixture of lemon, lavender, rosewood and rose essential oils were used while control group inhaled tea tree oil. Results: Depression was significantly decreased in patients in the experimental groups only. In Groups I and II patients, anxiety level was lower than that in control patients. Patients in Groups I and II also showed stronger physical resistance to stress than control group patients. Conclusion: Aromatherapy should be considered as a method that can significantly decrease depression in breast cancer patients who are undergoing adjuvant radiotherapy.

• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.72-79
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• 2009

Purpose: The purpose of this study was to test the correlation between the levels of spiritual well-being and spiritual nursing care of nurses for cancer patients and to provide baseline data for spiritual nursing care. Methods: In the study, there were 209 nurses involved who cared for cancer patients, and they were from Christian General Hospital in a city, Jeonju. Data were collected from September 17 to 30 in 2008 using structured questionnaires. The data were analyzed using research methods, including descriptive statistics, t-test, ANOVA, Duncan test, and Pearson correlation coefficients. Results: The mean score of spiritual well-being of nurses was $63.41{\pm}10.32$ (range $20{\sim}80$) and that of spiritual nursing care was $26.96{\pm}7.05$ (range $15{\sim}60$). There was a significant positive correlation between the spiritual well-being of nurses and their spiritual nursing care (r=.353, P=.000). Conclusion: The spiritual well-being and spiritual nursing care have a positive correlation. The level of spiritual well-being of nurses was relatively significant, whereas that of spiritual nursing care was relatively low. Therefore, it is recommended, for spiritual nursing care that nurses responsible for cancer patients should pursue more spiritual growth, attend church services regularly, and should further be educated in their care and responsibility.

• Journal of Hospice and Palliative Care
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• v.6 no.1
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• pp.11-21
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• 2003

This paper addresses the minor differences in the description of pain in Korean language in order to develop a standarized cancer pain aneument tool for Korean adults, Korean Cancer Pain Assessement Tool. The subtle differences in the meaning of expressions used cannot be translated into English and therefore we omiltted the English abstract.

• Journal of Hospice and Palliative Care
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• v.4 no.1
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• pp.4-13
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• 2001

Purpose : Since the acquired immune deficiency syndrome (AIDS) was first recognized in the United States in the summer of 1981, the number of these patients has been increasing in the world. But do not find out a cure and a vaccine for ARS (5). And so, the best treatment for AIDS is the prevention. People can find out accurate knowledge about AIDS, and they can prevent themselves from AIDS approximately 100%. In this study, we investigate with AIDS knowledge and attitudes in unmarried young men (<24 age) and suggest accurate preventive education for AIDS and good sexual behaviors. Methods : Un-married young soldiers and college students who were not diagnosed as AIDS until June 30, 2000 were included in the study. The study included a total of 923 men. A self evaluation questionnaire, included questions on 36 items(the part of demographic data - 9; the part of knowledge - 20; the part of attitudes - 8), was drawn up by three physicians. The demographic data, AIDS knowledge and attitudes were analyzed by chi-square analysis, and the total score of AIDS knowledge - comparison according to demographic factors and attitudewere analyzed by one-way ANOVA test. Results : In demographic characteristics, as for the first recognized time of AIDS, most of men knew it when they were in their middle school, as for sources of information on AIDS, most of them knew it through the TV-media, and as for the educational need about AIDS, most of them agreed with it. In AIDS knowledge, mean scores were $14.0{\pm}1.8$ (70.3%). Items of the misconceptions concerning AIDS, reported as less than 50% correct answers, were 6 among 20 items (30%). In AIDS attitudes, as for the item about that if I will be an AIDS patient, I will have an AIDS treatment, it showed that the number of men agreed with 759 (82.2%), and as for the item about that I will help for AIDS patient even though I don't know him, it showed that the number of them agreed with 412 (45.8%). In correlation of AIDS knowledge and demographic factors, the mean scores of knowledge of men with higher than college degree were higher than them of others. The mean scores of knowledge of men with total income of family with more than US$1667 were higher than them of others. The mean scores of knowledge of men with sources of information on AIDS through the TV-media were higher than them of others. And the mean scores of knowledge of men with past medical history of STD(sexually transmitted disease) were higher than them of others. Conclusions : The higher the knowledge he has, the lower the possibility of risk and the more positive the attitude he has. And then we think that the education program for AIDS will be included as a regular part of the curriculum in high school, and young men must be effectively educated by it.

• Journal of Hospice and Palliative Care
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• v.14 no.4
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• pp.218-226
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• 2011

Purpose: This study aimed to explore the public attitude toward the development of national health program for cancer survivorship. Based on the results of this survey suggest the necessity of national health program for cancer survivorship. Methods: We surveyed 1,015 adults who were over 20 years of age from the sixteen cities and local districts of Korea. We conducted a telephone survey with a structured questionnaire on the post-treatment care at the nation and on the permission as the handicapped for cancer. Results: Fifty-six percent of respondents answered that post-treatment program at the national level is very necessary and twenty-seven percent replied that it is necessary. Respondents emphasized 'Expanding insurance coverage for post-treatment care' (29.8%) and 'Systematic education and rehabilitation programs after treatment' (25.6%). This study found that a lower educational level [adjusted odds ratio (aOR)=1.36; 95% confidence interval (CI)=1.04~1.77], earning under 300 per month [aOR=1.36; 95% CI=1.04~1.77], being married (60.2%) [aOR=1.79; 95% CI=1.34~2.37] and thought higher level of cancer treatment in Korea than the advanced (64.4%) [aOR=1.56; 95% CI=1.15~2.12] influenced the positive attitude toward a national health program. Sixty-eight percent of respondents answered 'Strongly agree' or 'agree' to permission for cancer survivors as the handicapped. People who have been married (72.4%) [aOR=1.89; 95% CI=1.41~2.53] and who have had a lower educational level [aOR=1.35; 95% CI=1.03~1.78] responded that they agree more to permission for cancer survivors as the handicapped. Conclusion: This study shows the positive public attitude of the public toward the national health program for the cancer survivors.

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.47-55
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• 1998

Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

• Journal of Hospice and Palliative Care
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• v.5 no.2
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• pp.111-124
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• 2002

Purpose : Although the average life expectancy has increased due to advances in medicine, mortality due to cancer is on an increasing trend. Consequently, the number of terminally ill cancer patients is also on the rise. Predicting the survival period is an important issue in the treatment of terminally ill cancer patients since the choice of treatment would vary significantly by the patents, their families, and physicians according to the expected survival. Therefore, we investigated the prognostic factors for increased mortality risk in terminally ill cancer patients to help treat these patients by predicting the survival period. Methods : We investigated 31 clinical parameters in 157 terminally ill cancer patients admitted to in the Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital between July 1, 2000 and August 31, 2001. We confirmed the patients' survival as of October 31, 2001 based on medical records and personal data. The survival rates and median survival times were estimated by the Kaplan-Meier method and Log-rank test was used to compare the differences between the survival rates according to each clinical parameter. Cox's proportional hazard model was used to determine the most predictive subset from the prognostic factors among many clinical parameters which affect the risk of death. We predicted the mean, median, the first quartile value and third quartile value of the expected lifetimes by Weibull proportional hazard regression model. Results : Out of 157 patients, 79 were male (50.3%). The mean age was $65.1{\pm}13.0$ years in males and was $64.3{\pm}13.7$ years in females. The most prevalent cancer was gastric cancer (36 patients, 22.9%), followed by lung cancer (27, 17.2%), and cervical cancer (20, 12.7%). The survival time decreased with to the following factors; mental change, anorexia, hypotension, poor performance status, leukocytosis, neutrophilia, elevated serum creatinine level, hypoalbuminemia, hyperbilirubinemia, elevated SGPT, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), hyponatremia, and hyperkalemia. Among these factors, poor performance status, neutrophilia, prolonged PT and aPTT were significant prognostic factors of death risk in these patients according to the results of Cox's proportional hazard model. We predicted that the median life expectancy was 3.0 days when all of the above 4 factors were present, $5.7{\sim}8.2$ days when 3 of these 4 factors were present, $11.4{\sim}20.0$ days when 2 of the 4 were present, and $27.9{\sim}40.0$ when 1 of the 4 was present, and 77 days when none of these 4 factors were present. Conclusions : In terminally ill cancer patients, we found that the prognostic factors related to reduced survival time were poor performance status, neutrophilia, prolonged PT and prolonged am. The four prognostic factors enabled the prediction of life expectancy in terminally ill cancer patients.