• Journal of Hospice and Palliative Care
• /
• v.20 no.2
• /
• pp.93-99
• /
• 2017

Purpose: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. Methods: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. Results: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). Conclusion: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.

• Journal of Hospice and Palliative Care
• /
• v.16 no.4
• /
• pp.216-222
• /
• 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
• /
• v.19 no.4
• /
• pp.292-295
• /
• 2016

Hospice and palliative care in Taiwan has been growing continuously. The 2015 Quality of Death index, as rated by the Economist Intelligence Unit, ranked Taiwan first among Asian countries and sixth in the world. In this review article, we highlight three particular areas that might have contributed to this success; the laws and regulations, spiritual care and research network. Finally, we discuss the future challenges and prospects for Taiwanese encounters. A systemic review was conducted with the keywords "hospice palliative care Taiwan" using PubMed. The passing of the "Natural Death Act" in 2000 set the example and established a landmark for patient autonomy in Asia; it guarantees the patient's right to request that medical staff do not resuscitate (DNR) them and to reject other futile medical treatments at the end of their life, thus reflecting the importance of palliative care from the policy perspective. In 2015, Taiwan passed another pioneering law entitled the "Patient Autonomy Act". This law states that a patient may decline medical treatment according to his/her own will. Taiwanese indigenous spiritual care was launched in 2000. It requires a Buddhist Chaplain to successfully complete a training program consisting of lectures, as well as bedside practicum before applying Buddhist practices to end-of-life care. The Japan-Korea-Taiwan research network was established for the purpose of enabling collaborative research for the East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED) cohort. With consensus from the government and society to make it a priority, hospice and palliative medicine in Taiwan has been growing steadily.

• Journal of Hospice and Palliative Care
• /
• v.18 no.3
• /
• pp.208-218
• /
• 2015

Purpose: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. Methods: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. Results: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. Conclusion: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.

• Journal of the Korea Convergence Society
• /
• v.10 no.6
• /
• pp.393-399
• /
• 2019

This is a descriptive study on the perception and attitude toward DNR in adults. Structured questionnaires were used and 210 subjects were studied. In recognition of DNR, DNR was helpful for 'a comfortable dying(64.3%)'. The need for DNR in situation investigated 'For dignified dying (41.3%)' and 'to alleviate patient suffering(23.9%)'. Respondents who do not agree with DNR are shown 'Because legal issues can arise(61.7%)', 'Because human dignity is the life-sustaining priority(16.7%)'. In the attitude toward DNR, the most significant result was 'I want to know if I have an incurable disease (4.21).' There was no difference in attitudes toward DNR among adults. The DNR is not a method of Withdrawing in lifeprolonging treatment, It should be addressed in a comprehensive context in which human beings exercise autonomy over the process of dying and death.

• The Korean Journal of Health Service Management
• /
• v.10 no.3
• /
• pp.99-111
• /
• 2016

Objectives : This study developed an iPad-based animation for an electronic informed consent to directly help patients prepare an informed consent. The goal was to raise patients' understanding about the contents contained in a DNR informed consent in the current medical situation in which DNR informed consents are mostly written by a guardian. Methods : The development of a DNR electronic informed consent was done in 3 stages: analysis, design and development. The analysis stage was done with a survey on the real status of preparing a DNR informed consent in a medical institution. The design stage was done with the contents in the DNR electronic informed consent through a primary and secondary Delphi survey. The development stage created a DNR electronic informed consent and evaluated it through a tertiary Delphi survey. Results : After evaluating the appropriateness of the composition of the contents, the understanding of the contents, the convenience of use, the reflection of an expert opinion, and the suitability of the application, all had scores higher than 4 points. Conclusions : The results of this study show that our proposed DNR electronic informed consent can help patients better understanding the contents of a DNR informed consent.

• The Korean Journal of Rehabilitation Nursing
• /
• v.14 no.2
• /
• pp.118-128
• /
• 2011

Purpose: The purpose of this study was to explore the experiences of bereavement for main family members who had made and followed DNR decision for their family members. Method: This qualitative study was based on a grounded theory, and used in-depth interview techniques with the bereaved 10 main family members who had been treated and died under DNR order. Results: The causal condition of the family member was 'Releasing', and the main consequent phenomenon were 'Blaming self and ruminating'. The contextual condition was 'The memory of the deceased'. The action/reaction strategy was 'Purifying'. The intervening condition was 'Supporting system', and the consequence was 'Acceptance'. The experience after bereavement of the family member on DNR decision were rational processes that purified themselves and healed the guilt feeling about the decision from reflective assessment and response about DNR decision. Based on this results, the substantive theory 'Reflective self healing' was derived. Conclusion: The main family members in following DNR decision are more likely to have unhealthy emotional condition than others in normal bereavement process. But they overcame the grief of bereavement through reflective self healing process.

• Archives of Reconstructive Microsurgery
• /
• v.26 no.1
• /
• pp.18-22
• /
• 2017

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.

• Proceedings of the Korean Society of Computer Information Conference
• /
• 2019.07a
• /
• pp.195-198
• /
• 2019

연명의료결정법의 정식 명칭은 '호스피스 완화의료 및 임종 과정에 있는 환자의 연명의료 결정에 관한 법'이다. 이 법은 호스피스 완화의료에 대한 것과 환자의 연명의료 결정에 대한 것을 규정하고 있다. 특히, 후자의 연명의료결정에 관한 부분은 법제정 과정에서 법 종교 의료 윤리 등 다양한 분야에서 논박이 있었지만 2018년 2월 4일부터 시행되고 있다. 법학에서는 이 법이 생명이라는 법익과 관련되어 있어 형사법적, 민사법적으로 중요한 의미를 갖는다. 이 법이 탄생되기 위해 두 번의 변곡점이 있었다. 첫째, 1997년 '보라매병원 사건'에서 의사를 작위에 의한 살인방조죄로 판결한 사건 둘째, 2009년 '김 할머니' 사건에서 회생할 수 없을 경우 가족 등이 진술한 환자 의사에 따라 연명 의료를 중단할 수 있다는 대법원 판결이다. 연명의료결정법은 헌법상 생명권과 자기운명결정권이라는 기본권 충돌이 발생한다. 두 기본권이 서로 상충 할 때에는 어떠한 기본권을 우선해야 하는지가 실질적으로 문제되는데, 이익형량을 통한 규범의 조화로운 해석을 통해 해결해야 한다. 또한 이 법의 흠결과 문제점을 고찰하여 개정작업이 진행되어야 한다.

• Korean Circulation Journal
• /
• v.52 no.9
• /
• pp.659-679
• /
• 2022

Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.