• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.204-213
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• 2021

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

• Tuberculosis and Respiratory Diseases
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• 제78권3호
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• pp.175-179
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• 2015

The intensive care unit (ICU) is the most common place to die. Also, ethical conflicts among stakeholders occur frequently in the ICU. Thus, ICU clinicians should be competent in all aspects for ethical decision-making. Major sources of conflicts are behavioral issues, such as verbal abuse or poor communication between physicians and nurses, and end-of-life care issues including a lack of respect for the patient's autonomy. The ethical conflicts are significantly associated with the job strain and burn-out syndrome of healthcare workers, and consequently, may threaten the quality of care. To improve the quality of care, handling ethical conflicts properly is emerging as a vital and more comprehensive area. The ICU physicians themselves need to be more sensitive to behavioral conflicts and enable shared decision making in end-of-life care. At the same time, the institutions and administrators should develop their processes to find and resolve common ethical problems in their ICUs.

• 융합정보논문지
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• 제11권1호
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• pp.45-53
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• 2021

본 연구는 만성 심폐질환을 가진 말기 노인환자를 대상으로 연명의료결정 전후에 제공된 완화간호의 빈도와 변화를 파악하기 위한 후향적 조사 연구이다. 일개 대학병원 내과계 병동에 입원한 말기 심폐질환 노인환자 124명의 전자 의무기록을 조사한 결과, 연명의료결정 이후에 경구진통제 투여, 통증 경감을 위한 냉온요법과 마사지요법, 요로감염 시 약물투여와 소변 배양검사, 구강간호, 세발간호, 부분목욕의 제공은 유의하게 감소한 것으로 나타났다. 통증 경감을 위한 기도 및 이완요법, 호흡곤란 시 구·비강간호, 정서적 간호 제공은 연명의료결정 전후에 유의한 차이가 없었으며, 영적 간호는 전체적으로 가장 적게 제공된 것으로 나타났다. 따라서 심폐질환을 가진 말기 노인환자를 대상으로 연명의료결정 이후에 비약물적 통증관리와 안위간호의 개선이 필요하겠다.

• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.71-84
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• 2020

Purpose: The purpose of this systematic review and meta-analysis was to investigate the effects of advance care planning on end-of-life decision-making. Methods: Databases including RISS, KISS, KMbase, KoreaMed, PubMed (MEDLINE), Embase, and CINAHL were searched for studies that examined the effects of advance care planning interventions. The inclusion criteria were original studies in English or Korean; adults ≥18 years of age (population); advance care planning (intervention); completion of advance directives (AD) or advance care planning (ACP) (outcomes); and randomized or non-randomized controlled trials (RCTs and non-RCTs, respectively) (design). Study quality was measured using the checklists of the Joanna Briggs Institute. Meta-analyses were conducted with the Comprehensive Meta-Analysis program. Results: Nine RCTs and nine non-RCTs were selected for the final analysis. The effect sizes (ES) of the outcome variables in nine RCTs were meta-analyzed, and found to range from 0.142 to 0.496 for the completion of AD and ACP (ES=0.496, 95% CI: 0.157~0.836), discussion of end-of-life care (ES=0.429, 95% CI: -0.027~0.885), quality of communication (ES=0.413, 95% CI: 0.008~0.818), decisional conflict (ES=0.349, 95% CI: -0.059~0.758), and congruence between preferences for care and delivered care (ES=0.142, 95% CI: -0.267~0.552). Conclusion: ACP interventions had a positive effect on the completion of AD and ACP. To apply AD or ACP in Korea, it is necessary to develop ACP interventions that reflect aspects of Korean culture.

• 한국융합학회논문지
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• 제11권12호
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• pp.439-449
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• 2020

본 연구는 간호대학생들의 임종치료선호도에 영향을 미치는 요인을 확인하기 위해 수행되었다. 이 조사 연구는 2017년 12월부터 2018년 2월까지 수행되었으며, 최종 217명의 간호대학생의 자료가 수집되었다. '자율적 의사결정' 선호도에 영향을 미치는 요인은 교육수준(학년), 생명의료윤리 교육 수강, 죽음에 대한 태도, 연명치료에 대한 태도였다. '의료인의 의사결정'에 대한 선호도는 종교를 가지는 것과 관련이 있었다. '영성'에 대한 선호도에 영향을 미치는 요인은 교육수준(학년), 종교를 가짐, 전공만족도였다. '통증 조절'에 대한 선호도는 교육수준(학년), 사망한 환자 관찰경험, 나쁜 주관적 건강상태, 죽음에 대한 태도, 연명치료에 대한 태도와 관련이 있었다. 본 연구 결과는 간호학 전공 커리큘럼에서 연명치료, 생애말기간호 및 생애말기 의사결정에 관한 교육이 필수적임을 시사한다.

• Journal of Hospice and Palliative Care
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• 제11권3호
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• pp.140-146
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• 2008

목적: 말기 암 환자의 증가, 노년인구의 증가, 연명치료기술의 발달 등으로 완치될 수 없는 질환을 가진 말기 환자에 대한 치료 결정(End of life decision making)은 늘어나고 있다. 하지만 이에 대한 의료진의 태도나 환자 및 보호자의 인식은 낮은 상태에 있고 이로 인해서 말기 환자에게 말기진정과 같은 결정이 필요한 경우에 있어서도 그 시행에 많은 제약이 있으며 때로는 잘못된 시행으로 윤리적으로 어긋나는 경우가 발생되고 있다. 이에 의과대학 교육과정을 통하여 말기 환자 치료 결정에 대한 올바른 태도 변화를 가져올 수 있으며, 미래 의료계의 주역이 될 의과대학생들이 말기진정을 포함하여 능동적 안락사, 의사조력자살, 연명치료 유보 및 중단 등 말기 환자 치료결정에 대해 어떠한 태도를 가지고 있는가를 알아보기 위하여 본 연구를 시행하였다. 방법: 2007년 6월 25일부터 6월 29일 사이에 1개 의과대학 본과 1, 2학년 학생과 임상 실습중인 3학년 학생 총 388명을 대상으로 능동적 안락사, 의사조력자살, 연명치료 유보 및 중단, 말기 진정 등 말기 환자 치료결정에 대한 태도와 인구사회학적 자료를 설문 조사하였다. 응답이 완료된 267명을 대상으로 말기 환자 치료결정에 대한 태도와 각 인자들 간의 관련성을 분석하였다. 결과: 일개 의과대학생 267명을 대상으로 시행한 설문 조사에서 능동적 안락사, 의사조력자살, 연명치료의 유보 및 중단, 말기 진정의 시행에 찬성하는 비율은 각각 37.1%, 21.7%, 58.4%, 60.3%, 41.6%였다. 이 비율은 각 항목의 윤리적 타당성에 대한 설문 결과와 유사하였다. 1학년보다는 3학년에서 능동적 안락사와 의사조력자살은 더 반대하였고, 연명치료 유보 및 중단, 말기 진정에 대해서는 더 찬성하였다. 종교 활동 시간이 많을수록 각 항목에 대한 찬성이 적었으며 교육 경험 유무, 특히 임상실습경험이 있는 3학년 학생에서 말기 진정에 더 많이 찬성하였다. 연령, 임종 환자 경험 유무가 태도에 미치는 영향은 없었다. 결론: 말기 환자 치료 결정의 구체적 임상 행위에 대한 의과대학생의 태도에 이전 연구에서처럼 종교 또는 교육이 말기 환자 치료 결정에 영향을 미치는 것으로 나타났으며 특히, 임상실습을 통한 교육경험이 태도 변화에 중요하였다.

• 근관절건강학회지
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• 제20권3호
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• pp.214-224
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• 2013

Purpose: The purpose of this study was to identify the differences in preference for terminal care between hospitalized patients and nurses. Methods: A cross-sectional descriptive design was used in 79 patients and 107 nurses. The data were collected from August to October 2011, using the Preference for Care near the End of life Scale - Korean Version (PCEOL-K) with 5-point scale of 26 items. The reliability of the tool was Cronbach's ${\alpha}=.74$. Results: The mean score (SD) of PCEOL-K's sub-dimensions in nurses' priority was: (a) pain $3.70{\pm}0.63$, (b) spirituality $3.63{\pm}0.61$, (c) family $3.40{\pm}0.70$, (d) autonomous decision making $2.30{\pm}0.66$, and (e) decision making by healthcare professionals $2.14{\pm}0.64$. In patients' priority, the $M{\pm}SD$ score of each sub-dimension was: (a) pain $3.86{\pm}0.65$, (b) family $3.83{\pm}0.57$, (c) decision making by healthcare professionals $3.37{\pm}0.85$, (d) spirituality $3.01{\pm}0.80$, and (e) autonomous decision making $2.43{\pm}0.63$. Results indicated significant differences between nurses and patients regarding decision making by healthcare professionals (t=-11.28, p<.001), family (t=-4.66, p<.001), and spirituality (t=5.71, p<.001). Conclusion: The PCEOL-K of patients was higher than nurses'. A terminal care program for hospitalized patients at the end of life should be planned according to the results of PCEOL-K in nurses and patients.

• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.69-79
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• 2023

Purpose: This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods: A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results: In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion: The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

• 한국산학기술학회논문지
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• 제17권9호
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• pp.212-220
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• 2016

본 연구는 재가노인의 자기초월, 삶의 만족도, 임종기 치료선호도 정도를 파악하고 노인의 삶의 질을 향상시키기 위한 기초자료를 제공하기 위하여 시도된 서술적 조사연구이다. 연구대상자는 65세 이상의 노인 208명을 대상으로하고 자료수집은 2013년 8월부터 10월까지 실시하였다. 연구결과, 연구대상자의 자기초월 정도는 2.79점이며, 삶의 만족도 정도는 9.97점, 임종기 치료선호도 정도는 3.24점으로 나타났다. 자기초월은 교육수준이 높은 집단(F=3.38, p=.011)에서와 건강상태가 좋은 집단 (F=13.88 p<.001)에서, 삶의 만족도는 건강상태가 좋은 집단(F=24.42, p<.001)에서 유의하게 높게 조사되었다. 대상자의 자기초월은 삶의 만족도(r=.559, p<.001), 의료인에 의한 의사결정(r=.182, p=.008), 영성요인( r=..324, p<.001), 가족요인(r=.224, p<.001)과 유의한 순상관관계가 있는 것으로 조사되었으며, 삶의 만족도와 영성요인(r=.165, p=.017), 의료인에 의한 의사결정과 가족요인(r=.278, p<.001), 의료인에 의한 의사결정과 통증요인(r=.146, p=.035)이 유의한 순상관관계로 나타났으며, 자기초월이 임종기 치료 선호도에 영향을 미치는 요인으로 나타났다. 따라서 자기초월과 삶의 만족을 높일 수 있는 방안을 구축하고 임종기 대상자 관리를 위한 전략이 구체적으로 계획되어야 할 것이다

• 보건행정학회지
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• 제33권1호
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• pp.19-28
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• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.