• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.109-118
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• 2016

The purpose of this study was to evaluate Korean advance directives (K-AD) by examining the degree of adults' acceptance and reliability of the directive itself. Methods: Survey was performed with 181 adults aged 20 or older who were recruited from three regions. A questionnaire used to examine the participants' acceptance of their K-AD in terms of visual analogue scale score of complexity, difficulty, necessity, satisfaction, recommendation. Then, a retest was carried out by asking participants to write up a K-AD again to confirm the reliability of the directives. Results: On a scale of 100, the average acceptance score was 70 or above, which represents rather high level of acceptance in all five categories. The test-retest reliability kappa values ranged from 0.592 to 0.950, and the conformity degree was moderate or high. Regarding K-AD components such as values, treatment preference, proxy appointment, differences among age groups were observed in each component. Conclusion: The results of this study suggest that K-AD is a feasible instrument to analyze its acceptability and reliability for adult population. K-AD could be utilized to help people make their own decision on their end-of-life care. Further studies are needed to confirm this study results and promote widespread use of K-AD.

• Journal of Hospice and Palliative Care
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• v.11 no.2
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• pp.99-105
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• 2008

Purpose: In terminally ill cancer patients, accurate prediction of survival is necessary for clinical and ethical reasons, especially in helping to avoid harm, discomfort and inappropriate therapies and in planning specific care strategies. The aim of the study was to investigate prognostic factor of dying patients. Methods: We enrolled the terminal cancer patients from Kangnam St. Mary's Hospital from 2004 until their death. We observed symptoms shown in dying patients and assess 17 common symptoms shown in terminally ill cancer patients, performance status, pain and analgesic use. Results: Average period from hospitalization to death was 11.7 days. The most important prognostic factor is performance status (KPS), average KPS at enrollment is 48% and at last 48 hours is 25%. Physical symptoms that have significant prognostic importance are poor oral intake, weakness, constipation, decreased Karnofsky performance status, bed sore, edema, jaundice, dry mouth, dyspnea. Dying patients showed markedly decreased systolic blood pressure, cyanosis, drowsiness, abnormal respiration, death rattle frequently at 48 hours before death. Conclusion: If we assess the symptoms more carefully, we can predict the more accurate prognosis. The communication about the prognostic information will influence the personal therapeutic decision and specific care planning.

• Journal of Hospice and Palliative Care
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• v.14 no.2
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• pp.91-100
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• 2011

Purpose: This study was performed to investigate patients' preferences on receiving life-sustaining treatments (LST) and to analyze the relationship between patients' characteristics and LST selection. We also examined any discrepancy between LST patients' choices regarding medical intervention and actual medical intervention given/not given within 48 hours before death. Methods: This cross-sectional study was performed from March 1, 2008 to August 31, 2008 in the Palliative Care Unit of Korea University Hospital. Electric medical records (EMR) of 102 hospice cancer patients were reviewed, and 74 patients with Glasgow coma scale (GCS) ${\geq}$10 at the time of signing the advance medical directives (AMD) were selected for the first analysis. Then, patients alive at the end of this study, transferred to other hospitals or dead within 48 hours were excluded, and the remaining 42 patients were selected for the second analysis. Results: Preferred LST included antibiotics, total parenteral nutrition, tube feeding, transfusion, and laboratory and imaging studies. The relationship between patients' characteristics and LST could not be analyzed due to skewed preferences. LST chosen at the time of signing the AMD and actual medical intervention given/not given in the last 48 hours showed discrepancy in most cases. Conclusion: When making AMD in hospice cancer patients, it is important to consider the time and possibility of changing the choices. Above all, patients must fully understand the AMD. Thus, LST should always be provided with careful consideration of all possibilities, because legal and social aspects of AMD have not been established yet.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.90-97
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• 2013

Purpose: Ten years have passed since the Korean government announced its plan to institutionally support hospice and palliative care in 2002. In line with that, this study aims to suggest future directions for Korea's hospice and palliative care policy. Methods: We conducted a survey on people's perception and acceptance of well-dying. Data were collected from 1,000 participants aged 19~69 years between June 1 and June 11, 2012 via computer-assisted telephone interviews. Results: The most important factor for well-dying was placing no burden of care on others (36.7%) and the second most important factor was staying with their family and loved ones (19.1%). Among nine suggestions of policy support for well-dying, the most popular was the promotion of voluntary care sharing (88.3%), followed by the palliative care training support for healthcare providers (83.7%) and the support for palliative care facilities instead of funeral halls (81.7%). The idea of formulating a five-year national plan for end-of-life care drew strong support (91%). According to the survey, the plan should be implemented by the central government (47.5%), the National Assembly (20.2%) or civic groups (10%). Conclusion: This study demonstrated the public consensus and their consistent direction toward policy support for well-dying. Results of this study may serve as a foundation for the establishment of policy support for people's well-dying and palliative care at the national-level.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.7 no.2
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• pp.271-286
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• 2000

This study is designed to investigate what elders think about the meaning of aging. We have used Q-methods to identify meaning of aging from elders, and developed self-referenced surveys to analyze characteristics In this study, we used a non-structured method to select Q sampling. From 183 Q populations, we selected 36 Q sampling. A total of 32 persons sixty-years or older were randomly selected for P samples, When the Q-sorting was complete, we interviewed the participants at both end of the extremes(agree or disagree), and documented their responses. We used PC QUANL to process the data and used principal component analysis for Q factor analysis. There were five subjective types for the meaning of aging by elders. Of the 32 P-samples of elders, 11 were identified as Type 1, 7 as Type 2, 2 as Type 3, 8 as Type 4, and 4 as Type 5. Type 1 : 'Matured elders' Elders wished the well being of their children, thought older persons should maintain good health, worried about becoming senile, and dependent God believing in life after death. Type 2 : 'Assertive-Rights' Elders categorized as Assertive-Rights insisted on their rights to life as a person. Type 2 elders characterized themselves as people who should keep themselves healthy, become weak and lack sexual desires, act selfish like a child, need to be protected, and be financially independent. Type 3 : 'Passive-Dependents' Elders characterize themselves as those who pray for their children's well being, worry about the children even after their death. and becoming senile. Type 4 : 'Hopeless' The 'Hopeless' type of elders characterized aging as a time to pray for their children, insignificant beings, thoughts were selfish and child-like, poor, worried about going senile, regret their life overall, and preferred to die than to live as an old person. Type 5 : 'Attached-Present' The 'Attached-Present' type of elders thought elderly characterized themselves as acting selfish and child-like, wiser, anxious, regret their life, stand aloof of greed and worldly things, being a model for the society, and deserving to be treated with filial respect. Thus far, Korean elders seemed to have a positive and negative meaning of aging due to the current changes in the society, value system, and family structures. The above five subjective meanings of aging confirm that we need to approach and nurse the elderly differently. Years of aging are a part of and a natural process of life with various physical, psychological, and sociological changes. Nurses need to assist elderly to find the positive meaning of their life by providing appropriate physical, psychological, and social support at an earlier stage in nursing. Based on this study, we could derive the following two implication from the perspectives of science of nursing to care for elders. 1) Based on the studies investigating the type of meaning of aging, we could develop tools to assist in nursing intervention programs for elderly. 2) Based on research on the meaning of aging for different developmental stages of life, we could develop a model for roles for different family members in nursing and caring for the elders.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.26-36
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• 2017

Purpose: To explore the meaning of prayer in Korean patients with end-stage cancer who profess Christianity or Buddhism, given the significant differences between these religions. Methods: The Colaizzi (1978) analysis method was employed. In-depth interview were performed with 13 participants (seven Christians and six Buddhists) who were admitted to a University-affiliated hospital in Korea. Results: The six categories emerged: 1) communication with God, 2) mind discipline, 3) spiritual growth, 4) mysterious experiences, 5) perception of death and after-life, and 6) various forms of prayers. Conclusion: The participants' prayer experiences were described in a religious context. Christians believed that prayer is communication with God while Buddhists regarded it as disciplining of minds. Despite some differences between the religious groups, a general meaning of prayer was a desperate desire to solve their health issues by relying on God or someone who is more powerful than themselves. They also experienced personal and spiritual growth through prayer. This study explains the phenomenon of prayer experiences and shows that prayer is an important coping mechanism.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.21 no.1
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• pp.57-68
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• 2014

Purpose: Nurses' management of Nursing Home residents' remaining functional ability is phenomena emphasizing as the main practice focus in long term care and has specific meanings within the context of quality of life for fragile and disabled elderly people in nursing homes. This study was conducted to clarify and to conceptualize the phenomena of nurses' management of nursing home residents' remaining functional ability. Method: The Hybrid Model of concept development was applied to develop a concept of nurses' management of residents' remaining functional ability. Results: This concept of nurse' management emerged as a phenomenon having meanings in two different dimensions, deliberation and enactment for five types of residents: residents with declining function and dementia requiring nursing assistance, bed-ridden residents with moderate dementia, residents with advanced dementia and behavior problems, but good physical health, residents at the end of life stage, and bed-ridden residents with intact mental health. Conclusions: Results indicate that nurses' management of remaining functional ability of residents in nursing homes is a concept having types of needs that should be treated in specified ways. Interventions should have a positive impacts on practical applications in nursing homes and on enhancing residents' remaining function.

• Journal of Computing Science and Engineering
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• v.1 no.1
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• pp.1-30
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• 2007

In this paper we have provided an extensive survey of the databases and other resources related to the current research in bioinformatics and the issues that confront the database researcher in helping the biologists. Initially we give an overview of the concepts and principles that are fundamental in understanding the basis of the data that has been captured in these databases. We briefly trace the evolution of biological advances and point out the importance of capturing data about genes, the fundamental building blocks that encode the characteristics of life and proteins that are the essential ingredients for sustaining life. The study of genes and proteins is becoming extremely important and is being known as genomics and proteomics, respectively. Whereas there are numerous databases related to various subfields of biology, we have maintained a focus on genomic and proteomic databases which are the crucial stepping stones for other fields and are expected to play an important role in the future applications of biology and medicine. A detailed listing of these databases with information about their sizes, formats and current status is presented. Related databases like molecular pathways and interconnection network databases are mentioned, but their full coverage would be beyond the scope of a single paper. We comment on the peculiar nature of the data in biology that presents special problems in organizing and accessing these databases. We also discuss the capabilities needed for database development and information management in the bioinformatics arena with particular attention to ontology development. Two research case studies based on our own research are summarized dealing with the development of a new genome database called Mitomap and the creation of a framework for discovery of relationships among genes from the biomedical literature. The paper concludes with an overview of the applications that will be driven from these databases in medicine and healthcare. A glossary of important terms is provided at the end of the paper.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.214-219
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• 1998

Pain is one of the most frequent and disturbing symptom of cancer patients. And almost of cancer patients are afraid of a attacks of pain related to cancer. Caring for the cancer patient can be divided into two phases. The phase of "active treatment" involves various interventions-surgical, chemical or radiological- that are designed to prolong the patient's life. "Terminal care" is the period from the end of active treatment until the patient's death. But in the majority of clinical settings, cancer pain is not being managed adequately results from a lack of education about how to treat the cancer pain management in the safest and most effective way during terminal phase. Althought organic factors represent the most important cause of their pain, it is also important to deal with the patient's psychological reactions and to take account of his or her social and family environment if treatment for chronic cancer pain is to prove adequate. Thus we try to evaluate a kinds of cancer related to pain, degree of pain, effectiveness of drugs, and patient's responses to management. In regard to the satisfaction for pain relief in pain clinics at Pusan National University Hospital(PNUH) are about 70% in patients and 90% in family. Average life expectancy in cancer patients are about 140 days (3 days- 5.7 years). Cancer patients are complained of several discomfortness (above 30 kinds) such as, pain associated with cancer (75%), nausea and vomitting (38%), sleeping disorder (38%), anorexia (38%), dyspnea (32%), constipation (31%), etc. Distributions of cancer associated with pain are stomach cancer (21%), lung cancer (16%), cervix cancer (10%), anorectal and colon cancer (8.6%), hepatoma (8%), pancreatic cancer (3%). About 1/3 of patients are suffer from incident pain in 3~5 times in a day especially in moving, coughing, and exercise. Methods for drug delivering system before death are transdermal fentanyl patch (42%), intravenous PCA (21%), oral intake of opioid (17%), epidural PCA (14%), etc.

• Journal of Hospice and Palliative Care
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• v.10 no.3
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• pp.137-144
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• 2007

Purpose: The purpose of this study is to identify and assess the needs of the cancer patients and their families and provide basic data to meet with their needs. Methods: This is a descriptive study using questionnaire method. Questionnaire were collected by mail from 76 discharged patients from a hospice ward from May until the end of October, 2004, and data were analyzed by SPSS 10.0. Results: Admitted patients had needs of pain control (85.5%), non-pain symptoms (63.2%) such as vomiting, dyspnea, ascites, etc, and emotional and spiritual problem solving (28.9%, 14.5%). Interests of patients were health care of himself/herself (65.8%), concern for their spouses left alone (32.9%), and future of their children (15.8%). In families' needs of care of 5 areas, "information on patient's status and treatment/nursing care" was shown most high score ($3.48{\pm}0.62$). In detailed questions, they request most 'to inform the prognosis of patients' and the next is 'to inform the reasons that nursing care was required'. The next highest score was to 'inform family roles' ($3.39{\pm}0.64$), and next was spiritual support ($3.11{\pm}0.79$), and emotional support ($3.08{\pm}0.72$). Expectations of family on the treatment were comfortable dying (73.4%) scored the highest. Patients' families were satisfied with volunteer service most in service area (97.4%). The next was pain control (89.5%) and nursing service (77.6%). Conclusion: Health care staff should identify the actual needs of families caring cancer patients and they should operate realistic programme which can give continuous and assistance by reflecting individual needs and characteristics. With these srategies, the quality of life of patients and families can be improved. And then the intervention programme should be developed to measure subjective nursing care needs of terminally ill cancer patients and their families.