• 기본간호학회지
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• 제26권3호
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• pp.197-209
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• 2019

Purpose: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. Methods: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. Results: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=-3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=-2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=-3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. Conclusion: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.

• 기본간호학회지
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• 제17권4호
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• pp.450-459
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• 2010

Purpose: The purposes of this study were to identify awareness and attitudes toward advance directives (ADs) among Korean adults and to examine various opinions in the utilization of ADs among young, middle-aged, and older adults. Methods: Data were collected using a structured questionnaire from 384 adults selected by a quota sampling method on the basis of age. Results: The majority of participants preferred that they themselves would be the primary decision maker. Most of them were unaware of the option of ADs but supported the utilization of ADs. Most of the participants preferred detailed descriptions on end-of-life decisions in ADs but wanted to allow some leeway in following it. Significant differences were found among age groups in terms of the preferences regarding the utilization of ADs. Conclusion: It is suggested that nurses make efforts to educate the general public about ADs and facilitate advance care planning, which focuses on the process of communication on end-of-life preferences within the social network of relationships.

• Journal of Hospice and Palliative Care
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• 제24권3호
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• pp.135-143
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• 2021

End-of-life patients experience physical, mental, social, and existential distress. While medical personnel provide medication and care to alleviate patients' distress, listening to and interacting with patients remains essential for understanding their psychological condition. The most important tool, though difficult to implement in practice, is end-of-life discussion (EOLD). EOLD has been shown to have positive effects on end-of-life treatment choices, achievement of patients' life goals, improvements in the quality of life of patients and their families, and the prevention of depression and complicated grief among bereaved family members. EOLD is not often undertaken in clinical practice, however, due to hesitancy among medical personnel and patients for various reasons. In order to conduct an EOLD, the patient's judgment, psychiatric illnesses such as delirium and depression, and psychological issues such as the side effects of psychotropic drugs, denial, and collusion must be evaluated. Open and honest conversation, treatment goal setting, the doctor's familiarity with the patient's background, and attentiveness when providing information are important elements for any dialogue. Meaning-centered psychotherapy was developed to alleviate the existential distress of cancer patients, and its application may promote EOLD. The future development of meaning-centered psychotherapy in practice and in research is expected to further promote EOLD.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.7-17
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• 2023

Purpose: The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). Methods: We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Results: Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. Conclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.

• Journal of Hospice and Palliative Care
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• 제15권4호
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• pp.188-192
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• 2012

Palliative medicine has shown demonstrated benefit for patients with serious illness, their families, and hospital systems. As such, the demand for palliative care services is growing at a fast pace, and health care facilities frequently struggle to develop and implement effective and sustainable methods of providing this care. As with any new system, challenges and barriers naturally exist to instituting palliative care. Undertaking careful assessment, planning, and resource allocation can provide the greatest likelihood of success when developing these novel yet much needed models of care. This summary paper offers a qualitative overview of the potential benefits and the rationale to implement robust palliative care systems. We briefly review the history of palliative medicine in the broadest sense and address several seminal works from the US palliative care literature. Core practices to establish and advance palliative medicine are suggested. Commentary is provided on some of the particular barriers to palliative system development that may need to be addressed in the context of Korean medical culture. Collectively, we hope this overview can contribute to a framework within which such research and development can occur, leading to increasingly effective and sustainable palliative medicine in Korea.

• 대한가정학회지
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• 제32권2호
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• pp.61-78
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• 1994

This study was to provide the basis for the development of family life education programs for caregiving families. The data were collected from 374 adult children who were giving care to their older parents in Seoul. Adult children reported experiencing more caregiving problems in the areas of personlities of older parents psychological burden and parents' health than in the areas of caregiver's health and financial burden Women were more likely to experience caregiving problems than men. Adult children indicated higher levels of perceived knowledge on planning for later life psychological characteristics of older parents and keeping good relationships with older parents. They reported more need for knowledge on physical change of older parents and planning for later life while there were less need for knowledge on sharing caregiving roles with others and social service programs. The needs for caregiving education were also identified in the aspects as to participation purposes methods times and agencies. Given these findings this study suggests some practical implications for the development of family life education programs for caregiving families. Further studies should help to advance the development and practice of family life education programs for caregiving families.

• 근관절건강학회지
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• 제20권3호
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• pp.197-206
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• 2013

Purpose: The purpose of this study was to investigate end-of-life care preferences of employees working in a university hospital. Methods: Of 650 eligible employees that were approached, 607 employees (386 nurses, 93 physicians, and 128 general staff) completed the Korean version of Preferences for Care Near the End of Life (PCEOL-K). Results: Among 5 dimensions of the PECOL-K, "Pain" was the most preferred care dimension and "Decision making by health care professional" was the least preferred care dimension. The item that received the highest mean score was "I want to let nature guide my dying and I do not want my life to be artificially prolonged in any way", and the lowest item was "I want health care providers to make all decisions about my care". As preferred care near the end of life, nurses gave lower scores to the life sustaining treatment and decision making by health care profession than physicians and general staff. Compared to physicians and nurses, general staff preferred the decision making by health care professional and by family. Conclusion: The results show that adequate pain relief is the most preferred care at the end of life among hospital employees and non-medical personnel preferred decision making by others.

• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.93-102
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• 2020

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

• Journal of Hospice and Palliative Care
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• 제13권1호
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• pp.41-49
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• 2010

목적: 본 연구는 간호사들의 임종기 동안의 치료 및 간호와 관련한 간호사 자신의 선호도를 확인하기 위하여 수행되었다. 방법: PCEOL-K를 이용하여 자료를 수집하였으며 본 도구는 미국에서 개발되고 한국판 표준화를 거친 도구이다. 연구대상자는 본 연구 참여를 허락한 일 종합병원의 간호사 200명이었으며 총 177매의 자료가 분석에 활용되었다. 결과: 본 연구 대상 간호사들은 임종기 치료 및 간호에 있어 통증관리 및 영적 요구지지에 대한 긍정적 선호도를, 의료인에 의한 치료 결정에 대해서는 부정적 선호도를 나타내었다. 결론: 본 연구 결과 간호사들은 임종기 치료 및 간호에서 개인의 자율성, 통증관리, 영적 요구 지지를 중요하게 생각하고 있었다. 앞으로 다양한 집단, 즉 의사, 환자, 가족들을 대상으로 각 집단별 선호도를 확인하는 노력이 요구된다.

• 근관절건강학회지
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• 제27권3호
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• pp.229-237
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• 2020

Purpose: This paper aims to clarify the concept of well-dying in the sociocultural context of Korea. Methods: Walker and Avant's method was chosen for the concept analysis. Through a literature review of 36 papers, the attributes and definition of well-dying were derived. Results: The literature revealed that in Korean society, well-dying is defined as the process of actively preparing for death throughout life. The attributes of the concept are a reflection on death, death acceptance, searching for meaning, transcendence, advance decision-making, and sharing values with family. The motivation for thinking about death, the hope of dying with dignity, and the Korean cultural view of death precede the concept, followed by dying with dignity, personal and family happiness, and improved quality of life and death. Conclusion: This study may lead to the unification of concept use based on mutual understanding, thus enabling effective communication in research, education, and clinical settings. This can be the rationale for the development of tools and educational programs as well as establishing policies related to well-dying in Korea.