• Quality Improvement in Health Care
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• v.26 no.2
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• pp.86-94
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• 2020

Purpose: This study aimed to identify current quality control (QC) practices of primary care clinics participating in the National Cancer Screening Program (NCSP) in Korea. Methods: A nationwide survey using a structured questionnaire was conducted among the primary care clinics participating in the NCSP, which were selected by a proportionate stratified sampling. The questionnaire consisted of general information about the responding clinics and the scope of QC activities undertaken. A total of 360 clinics responded and the set of data was then analyzed with Chi-square test and multivariable logistic regression analysis. Results: Among 360 respondents, 332 (92%) reported that they were involved in the QC activities. Most frequently performed QC activities were 'maintenance of facility and instruments' (89%) and 'staff training' (85%). The analysis revealed, with statistical significance (p<.05), that there was an association between certain characteristics of the clinics and the scope of QC activities. These findings also indicated that the diversity of QC practices varies according to the size of the clinics. The clinics screening more types of cancer, those with more screenees, and those with more employees were more likely to implement various QC activities including 'maintenance of facility and instruments', 'external quality control', and 'management of screening data'. Conclusion: To our knowledge, this is the first study to investigate the current status of QC activities conducted among primary care clinics participating in the NCSP. The results of this survey can be used as a basis for further development of policies on quality management of small- and medium-sized primary care clinics in Korea. However, further studies encompassing various aspects of QC activities and management of primary care clinics are needed to assess the current situation in a concise manner.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7359-7366
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• 2013

Objective: To assess the effects of perioperative comprehensive supportive care interventions on outcome of Chinese esophageal cancer patients in a prospective study. Methods: 60 patients with primary esophageal carcinoma were randomized into an intervention group (IG, n=31) and a control group (CG, n=29). The Chinese version of symptom checklist-90 (SCL-90) was adopted to assess their psychological status. The interventions, including health education, psychological support, stress management, coping strategies and behavior training, were carried out in 3 phases (preoperative, postoperative I and postoperative II), and psychological effects were thereafter evaluated accordingly before surgery, and 1 week, 4 weeks and 24 weeks post-surgery. Medical costs were estimated at discharge. Survival of patients was estimated each year post-surgery. General health status and satisfaction-with-hospital were surveyed by a follow-up questionnaire 4 years post-surgery. Results: All the subjects demonstrated higher scores in the preoperative phase than the normal range of Chinese population concerning 7 psychological domains including somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety and paranoid ideation. Although no significant difference was observed between the two groups at admission, the scores of IG, which tended to decrease at a faster rate, were generally lower than those of CG at weeks 1, 4 and 24 post-surgery. The length of hospital stay and medical costs of IG were significantly less than those of CG and satisfaction-with-hospital was better. However, there was no significant difference in 4-year survival or health status between two groups. Conclusions: Appropriate perioperative comprehensive supportive care interventions help to improve the psychological state of Chinese patients with esophageal carcinoma, to reduce health care costs and to promote satisfaction of patients and their families with hospital.

• The Korean Journal of Rehabilitation Nursing
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• v.18 no.1
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• pp.11-19
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• 2015

Purpose: The purpose of this study was to identify the perception on hospice, attitudes toward death and needs of hospice care between the patients with cancer and family. Methods: This study used descriptive research design. The participants were 118 patients with cancer hospitalized and 118 family caregivers of patients with cancer. The data collected by questionnaires from October to December, 2013. Results: There was significant difference in perception on hospice (recognition of hospice term and definition of hospice) and needs of hospice care between patients and family. Among the categories of the needs, 'medical needs' was the highest in patients and 'emotional care' was the highest in family. But there was no significant difference in attitudes toward death. There correlation between attitudes toward death and needs of hospice care was significant only in patients. Conclusion: Hospice care must be provided considering the death attitudes and needs of patients with cancer and family based on the understanding of perception on hospice, attitudes toward death of the patients with cancer and family.

• Journal of Hospice and Palliative Care
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• v.24 no.3
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• pp.184-193
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• 2021

Purpose: This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for life-sustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. Methods: This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. Results: The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). Conclusion: This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

• Journal of Hospice and Palliative Care
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• v.25 no.4
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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.

• Research in Community and Public Health Nursing
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• v.32 no.3
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• pp.356-367
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• 2021

Purpose: This study conducted an economic evaluation of hospital-based home care services for the patients who had undergone breast cancer surgery. Methods: A total of 12,483 patients over 18 years of age who had received breast cancer surgery in 26 tertiary hospitals in 2018 were analyzed with the claim data from the Health Insurance Review & Assessment Service using cost-minimization analysis and societal perspectives. Results: There were 156 patients who utilized hospital-based home care services within 30 days after breast cancer surgery, and they received 2.17 (SD=1.17) hospital-based home care service on average. The average total cost was 5,250,028 KRW (SD=1,905,428) for the group receiving continuous hospital-based home care and 6,113,402 KRW (SD=2,033,739) for the group not receiving continuous hospital-based home care (p<.001). The results of the economic evaluation of continuous hospital-based home care services in patients who had undergone breast cancer surgery indicated a total benefit of 953,691,000 KRW, a total cost of 819,004,000 KRW, and a benefit-cost ratio of 1.16 in 2018. Conclusion: Continuous hospital-based home care was considered economically feasible as the total costs for the group receiving continuous hospital-based home care were lower than those of the group not receiving continuous hospital-based home care. Therefore, policy modification and financial incentives are recommended to increase the utilization of hospital-based home care services for patients who had undergone breast cancer surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.671-676
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• 2012

Objectives: Screening for second primary cancer (SPC) is one of the key components of cancer survivorship care. The aim of the present study was to explore oncologists' experience with promoting second primary cancer screening. Methods: Two focus group interviews were conducted with 12 oncologists of diverse backgrounds. Recurrent issues were identified and placed into thematic categories. Results: Most of the oncologists did not consider SPC screening promotion as their responsibility and did not cover it in routine care. All of the study participants had experience with unexpected SPC cases, and they were under emotional tress. There was no systematic manner of providing SPC screening. Oncologists usually prescribe SPC screening in response to patients' requests, and there was no active promotion of SPC screening. Short consultation time, limited knowledge about cancer screening, no established guideline for SPC screening, and disagreement with patients about oncologists' roles were major barriers to its promotion. An institution-based shared care model was suggested as a potential solution for promoting SPC screening given current oncology practices in Korea. Conclusion: Oncologists could not effectively deal with the occurrence of SPC, and they were not actively promoting SPC screening. Lack of knowledge, limited health care resources, and no established guidelines were major barriers for promoting SPC screening to cancer survivors. More active involvement of oncologists and a systematic approach such as shared-care models would be necessary for promoting SPC screening considering increasing number of cancer survivors who are vulnerable.

• Journal of Hospice and Palliative Care
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• v.13 no.2
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• pp.69-75
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• 2010

Hospice is defined by the National Hospice and Palliative Care Organization (NHPCO, USA) and WHO, as a program of care that provides comprehensive medical, nursing and support services to dying patients and their family. Despite its broad definition, however, hospice care in Korea has been focused mostly on terminal cancer patients. Thus hospice eligibility for patients with advanced cancer is relatively easier to predict than those with other fatal chronic illnesses such as heart, lung, renal or liver diseases, and dementia. This makes it more difficult for patients and families to prepare for death and gain full benefits of hospice care. This article introduces the medical guidelines for selected non-cancer patients who are expected to live for only six months, this making it possible for patients, who are nearing the end of life, to avoid unwarranted suffering.

• Korean Journal of Hospice Care
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• v.6 no.2
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• pp.1-9
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• 2006

In this thesis, Chapter I Introduction suggested the necessity of this research and defined related terms, and Chapter II defined hospice for children and examined the symptoms of pediatric cancers as well as the general characteristics of pediatric cancer patients. In particular, we surveyed the physical condition, psychological and emotional condition, financial condition, environmental aspect, educational aspect and spiritual aspect of pediatric cancer patients’ families, investigated pediatric cancer patients’ parents and siblings with regard to their understanding of the pediatric cancer patients’ death, and lastly considered spiritual care. Chapter III presented summaries and conclusions. In their developmental stage, pediatric cancer patients lack abilities to express themselves and are highly dependent on their parents, so parents who take care of cancer children have to make hard decisions and cancer children’s families are heavily burdened by the situation of preparing their children’s death and sending them away while denying their death, and for this reason they need help from specialists. That is, for pediatric cancer patients, we need highly experienced pediatricians or nurses skilful in managing young terminal patients as well as hospice counseling and family counselors for consulting on family crises. In particular, there is a keen need of child life support specialists. In addition, clergymen’s help is critical for spiritual care to ease the fear and terror of the unknown world, fear of death, etc. Moreover, in order to prevent cancer children from failing to adjust themselves to school life or peer relation after recovery, hospice service should provide cancer children with opportunities to learn school curriculums and associate with friends.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.3363-3368
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• 2013

Background: The burden due to cancers is an emerging public health concern especially in resource-limited countries like Nigeria. The WHO estimates that cancer kills more people than tuberculosis, HIV/AIDS and malaria combined. As people in Nigeria and other developing countries are beginning to survive infectious diseases, there is an observed epidemiologic transition to chronic diseases, such as cancers. In 2008, 75 out of 1,000 Nigerians died of cancer. Despite the rising incidence and public health importance, Nigeria lacks an organized and comprehensive strategy to deal with cancers. Materials and Methods: This article reviewed 30 peer-reviewed manuscripts on cancer care in four countries. It highlights the limitations to cancer care in Nigeria; due to lack of awareness, low health literacy, absence of organized screening programs, inadequate manpower (in terms of quality and quantity) as well as limited treatment options. Results: This review led to the formulation of a proposal for Nigerian National Cancer Policy, mainly drawn from effective strategies used in Canada, Brazil and Kenya. This is a vertical cancer program that is patient-centered with an emphasis on tobacco control and cancer disease screening (similar to Canada and Brazil). Additionally, it emphasizes primary cancer prevention (similar to Kenya). Its horizontal integration with other disease programs like HIV/AIDS will improve affordability in a poor resourced country like Nigeria. Capacity building for health professionals, hub-and-spoke implementation of screening services, as well as investment in effective treatment options and increased research in cancer care are essential. International 'twinning collaborations' between institutions in richer countries and Nigeria will enhance effective knowledge translation and improve the quality of patient care. Conclusions: A national cancer policy must be developed and implemented in Nigeria in order to overcome the present limitations which help contribute to the observed increases in cancer morbidity and mortality rates. Cancer control is feasible in Nigeria if the nation was to consider and employ some of the cost-effective strategies proposed here.