• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.23-29
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• 1998

Purpose : Validity of WHO guideline of cancer pain management has been proven and many trials were done for resolution of inadequate management of cancer pain. We assessed the severity of pain in terminal cancer patients and patient's characteristics influencing inadequate pain management. Methods : This study was done on 100 patients who was confirmed as terminal in Seoul National University Hospital from lune 1997 to November. For getting the informations about dermographic and medical characteristics such as performance and metastasis, and drug-adjusted pain severity the patients, we reviewed the medical records and interview the patients. we assessed the adequacy of prescribed analgesics with WHO guidelines of pain management, and patient's characteristics influencing on adequacy of pain management. Results : 85.0 percent of cancer patient had pain when diagnosed as terminal cancer and 68% of patient had pain above moderate severity. 38.0 percent of those were given inadequate pain management and the greater pain severity, the less adequate(P<0.001). Sex, age, primary site of cancer, metastasis, symptoms such as depression and anxiety, and performance were not significant. Conclusion : Despite guidelines for pain management, many patients with terminal cancer received inadequate pan management. Their is a need for education about evaluation of pain and guidelines of pain management.

• Journal of Hospice and Palliative Care
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• v.17 no.4
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• pp.270-277
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• 2014

Purpose: This is a retrospective study that investigated cancer patients' complaints of moderate or severe pain to analyze pain characteristics, pain relief interventions and their effects. Methods: The participants of this study were 363 patients who were hospitalized in the cancer ward for three to 30 days and scored 4 points or higher on the pain severity assessment. Results: The most frequent region of pain was the abdomen. The most frequent factor that exacerbated pain was movement. The most frequent pain alleviating factor was administration of analgesics. The most frequent pain type was breakthrough pain, and the most frequent non-pharmaceutical intervention for pain control was heat therapy. Among all, analgesics were routinely prescribed for 52.2% of the participants. Morphine sulfate was the most frequently used analgesic while Gabapentin was the most frequently used non-narcotic analgesic. At the time of discharge, 82.5% of the participants marked their pain intensity as 3 points or lower. Conclusion: For cancer patients complaining of moderate or severe pain, it is important to actively control pain from the beginning of admission. Thus, it is necessary to educate not only cancer patients using narcotic analgesic for pain control and their families but nurses about the effects and side-effects of drugs. Moreover, patients and their families need to learn how to assess and record pain at home to collect data that can be referred for future treatment.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.131-135
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• 2017

Purpose: Oral naloxone is combined with oxycodone to alleviate or prevent opioid-induced constipation in cancer pain patients. However, there is still concern that oral naloxone may precipitate opioid withdrawal symptoms in patients on opioids. We retrospectively investigated clinical characteristics of cancer patients who experienced opioid withdrawal symptoms. Methods: We reviewed medical records of all patients who were prescribed with oral oxycodone/naloxone at a tertiary cancer center from January 1, 2012 through December 31, 2016. Eligible patients were screened based on demographics, opioid and naloxone dosages, clinical manifestation and pain intensity. Results: Among a total of 1,641 patients, 10 patients were selected. Seven patients were male, and the average age was 68.1 years. The median dose of naloxone that induced withdrawal symptoms was 20 mg. Most common withdrawal symptom was shivering (seven patients) followed by cold sweating (five), and muscle twitching (five). Other symptoms included restlessness, fever, dizziness, and yawning. Pain was exacerbated from the median intensity of numeric rating scale (NRS) 3 to NRS 6. Conclusion: Opioid withdrawal symptoms may occur when switching to oral oxycodone/naloxone for cancer patients who have been treated with other strong opioids. A prospective, multicenter study on this issue should be conducted in future.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.216-222
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• 2013

Purpose: The purpose of this study was to examine nurses' emotional responses and ethical attitudes towards elderly patients' Do-Not-Resuscitate (DNR) decision. Methods: Data were collected using a questionnaire which was filled out by 153 nurses who worked in nursing homes and general hospitals. Data were analyzed using real numbers, percentages, means, standard deviations and Pearson's correlation coefficients with SPSS 19.0 program. Results: The average score for ethical attitudes towards the DNR decision was 2.68 out of 4. Under the ethical attitudes category, the highest score was found with a statement that said 'Although they will not perform cardiopulmonary resuscitate (CPR), it is right to do their best with other treatments for DNR Patients'. Items regarding emotional responses to the DNR decision, the average score was 2.36 out of 4. Among them, the highest score was achieved on 'I understand and sympathize'. No significant correlation was found between ethical attitudes and emotional responses in relation to patients' DNR decision (r=-0.12, P=0.13). Conclusion: Regarding elderly patients' DNR decision, nurses showed somewhat highly ethical attitudes and slightly positive emotional response. A follow-up study is needed to investigate variables that affect our results.

• Journal of Hospice and Palliative Care
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• v.16 no.1
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• pp.1-9
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• 2013

Purpose: The aim of this study was to investigate nursing students' awareness of biomedical ethics and attitudes toward death of terminal patients. Methods: A structured questionnaire was developed to examine nursing students' biomedical ethics. Their attitudes toward terminal patients' death were measured by using the Collett-Lester Fear of Death Scale. Surveys were conducted with 660 nursing students enrolled at a three-year college located in Daejeon, Korea. Data were analyzed using descriptive statistics, Wilcoxon rank sum test and Kruskall Waills test. Results: Students who have experienced biomedical ethics conflicts, agreed to prohibition of cardiopulmonary resuscitation (CPR) and have no religion exhibited more negative attitudes toward death compared to students without the above characteristics. Of the participants, 81.2% answered that life sustaining treatment for terminal patients should be discontinued and 76.4% replied that CPR on terminal patients should be prohibited. The majority of the correspondents stated that the two measures above are necessary "for patients' peaceful and dignified death". Conclusion: Study results indicate the need to establish a firm biomedical ethics value to help nursing students form a positive attitude toward death. It also seems necessary to offer students related training before going into clinical practice, if possible. The training program should be developed by considering students' religion, school year, experience with biomedical ethics conflicts and opinion about CPR on terminal patients. The program should also include an opportunity for students to experience terminal patient care in advance via simulation practice on standardized patients.

• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.61-71
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• 2009

Purpose: The purpose of this study was to develop a CD program of applied logotherapy for psycho spiritual care of late adolescents with terminal cancer. Methods: Keller & Song's ARCS theory and a model for developing learning materials was applied to develop this program composed four distinct phases: planning, designing, developing, and evaluation stages. Results: This program was entitled 'Finding meaning in my life' and consisted of 5 sessions and its educational contents were made up as follows: "First Secret" is 'learning three natures of the human mind', "Second Secret" is 'learning creative values first method to find meaning of life', "Third Secret" is 'learning experiential value as second method to find meaning of life', "Fourth Secret" is 'learning attitudinal value as third method to find meaning of life', and "Fifth Secret" is 'Becoming the master of my life'. The sub-menu was made up of 'Beginning', 'Opening mind', 'Learning'. 'Laughing Song', 'Experiencing'. Conclusion: This CD program applied logotherapy with flash animation technique as an emotional and spiritual nursing intervention program for easier and more scientific application in pediatric oncology and hospice care area.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.113-121
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• 2014

The major symptoms of terminally ill cancer patients are fatigue, loss of energy, feeling of helplessness, poor appetite and pain as well as general weakness, which are very similar to symptoms of adrenal insufficiency. Adrenal insufficiency-induced symptoms widely vary from mild symptoms to life-threatening conditions and may be resulted from variable medical causes. For terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. The use of acute or chronic opioid agents is believed to negatively affect adrenal gland function. In most studies of opioid effects (preclinical/clinical with animal subjects or and patients suffering non-malignant pain, adrenal insufficiency and hormonal abnormalities were observed as side effects. However, opioid-induced adrenal insufficiency has been rarely reported in studies with patients with malignant cancer pain. Relationship between the type, treatment period, dosage of opioid agents and hormonal abnormalities can be examined by measuring the functional level of the adrenal glands. We hope to improve patient's quality of life by indicating hormone substitution to treat symptoms of adrenal insufficiency.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.161-169
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• 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
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• v.12 no.4
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• pp.177-193
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• 2009

The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.

• Journal of Hospice and Palliative Care
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• v.6 no.1
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• pp.1-10
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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 Caancer Pain Assessement Tool. The subtle differences in the meaning of expressions used cannot be translated into English and therefore we omiltted the English abstract.