• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.51-59
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• 2023

Purpose: We evaluated the status of patients enrolled in South Korea's pediatric palliative care pilot project based on the experience of a single center. This study examined factors related to end-of-life services and differences in medical costs. Methods: The medical records of 120 patients referred by a pediatric palliative care team were analyzed retrospectively. Data from July 1 to February 28, 2022 were collected and analyzed using the chi-square test and the Mann-Whitney U test. Results: Volunteer programs and psychological support (100%), family support and education (99.2%), and financial support through institutional linkage (62.5%) were provided to the participants. In the deceased group, there were no significant differences in general characteristics, which included age, gender, primary disease, religion, duration of hospitalization in an intensive care unit (ICU) and non-intensive care unit (non-ICU). However, the ICU group had fewer opportunities to access individual pain and physical symptom management than the non-ICU group and there were limitations in linking with external resources. Medical expenses were significantly different for the ICU group, with a 3-times higher average cost than the non-ICU group. Conclusion: Although an individualized approach is needed for each patient in pediatric palliative care, psychosocial care is essential. In addition, if early intervention for end-of-life pediatric patients is available from a palliative care team, the cost burden of medical care for patients and their families should be minimal.

• Journal of Hospice and Palliative Care
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• 제23권1호
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• pp.11-16
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• 2020

Purpose: D-dimer levels are known to be associated with poor outcomes in patients with various cancers, but their significance at the end of life remains unclear. This study investigated D-dimer levels as a prognostic indicator for terminal cancer patients in the last hours of life. Methods: The retrospective study was conducted at a palliative care unit of a tertiary cancer center, using a database to analyze the records of patients treated from January 1, 2010 to December 31, 2018. In total, 67 terminal cancer patients with available data on D-dimer levels were included. Patients' demographic data, clinical information, and laboratory values, including D-dimer levels, were collected. Survival was analyzed using the Kaplan-Meier method and the log-rank test. A Cox proportional-hazards model was used to identify prognostic factors of poor survival. Results: The most common site of cancer was the lung (32.8%) and the median survival time was 5 days. Most laboratory results, particularly D-dimer levels, deviated from the normal range. Patients with high D-dimer levels had a significantly shorter survival time than those with low D-dimer levels (4 days vs. 7 days; P=0.012). In the Cox regression analysis, only a high D-dimer level was identified as a predictor of a poor prognosis (hazard ratio, 1.83; 95% confidence interval, 1.09~3.07). Conclusion: Our results suggest that at the very end of life, D-dimer levels may serve as a prognostic factor for survival in cancer patients.

• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.1-11
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• 2022

The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for end-of-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified "terminal stage." The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients' wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient's judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients' right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.

• Journal of Hospice and Palliative Care
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• 제5권2호
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• pp.155-162
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• 2002

목적 : 본 연구는 자원봉사자 교육 프로그램 개발을 위한 기초자료로서 질병 말기 환자에게 호스피스 케어를 제공하는 자원봉사자의 관점에서 본 서비스 요구도를 조사하고자 하는데 그 목적을 두고 있다. 방법 : 경상남도, 부산시 및 충청남도 지역의 호스피스 자원봉사 교육 수료자로서 호스피스 케어 제공 경험이 있는 자원봉사자인 연구대상 중 88명이 본 연구를 위한 분석대상으로 사용되었으며, 구조화된 설문지를 이용한 자기기입식 설문방식에 의해 조사되었다. 수집된 자료는 SPSS Window version 10.0 통계 프로그램을 이용하여 빈도, 백분율, 평균, 표준편차 및 회귀분석방법에 의해 분석되었다. 결과 : 조사대상자의 사회인구학적 특성은 기독교 중류가정의 40대 유배우 고졸 여성으로 가족 중 호스피스 경험이 없는 경력 1년 미만의 호스피스 센터에 소속된 사람이었다. 정보영역에서 호스피스 케어 요구도가 가장 높았으며 사회경제적 영역에서 가장 낮았다. '질병과 치료과정에 대한 정보 제공 필요'에 대한 요구가 정보영역에서, '욕창관리 및 예방'에 대한 요구가 신체적 영역에서, '의료인과 지속적인 관계유지 도와줌'이 정서적 영역에서 그리고 '의료보험 지원 확대를 도와줌'이 사회경제적 영역에 대한 요구도 중 가장 요구도가 높은 것으로 나타났다. 호스피스 케어 전체 영역 및 신체적 영역에 영향을 미치는 요인으로는 '가족 중 호스피스 경험'이, 정서적 영역에서는 '호스피스 경력'과 '가족 중 호스피스 경험'이 영향을 미치는 요인 변수로 예측되었으나 정보영역 및 사회경제적 영역에서는 어떤 변수도 영향을 미치지 않는 것으로 나타났다. 결론 : 본 연구가 편의표본을 사용하여 시행되었기에 본 연구의 결과가 실제적이고 효과적인 자원봉사자 교육 프로그램 개발을 위한 자료로 일반화되어 사용되기에는 한계를 지니고 있다. 따라서 호스피스 센터 별 전수조사 혹은 확률표본추출법에 의해 설계된 본 주제와 관련된 조사연구 및 질적 방법에 의한 연구가 필요하리라 사료된다.

• Journal of Hospice and Palliative Care
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• 제8권1호
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• pp.52-56
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• 2005

Herpes zoster (HZ) is an acute infection of the unilateral sensory dermatome caused by varicella-zoster virus (VZV) and is characterized by vesicular eruption and unilateral pain along the involved dermatome. Although the pathogenesis of HZ is incompletely understood, it is thought that when cell-mediated immunity falls below a critical level, dormant VZV within cells of the sensory ganglia are allowed to replicate and infect the host with the resultant clinical presentation of HZ. It has been associated with immunosuppressed states, such as advanced age, leukemia, lymphoma, chemotherapy and/or radiation treatment. We present a case of a 62-year-old female patient with malignant lymphoma suffering herpes zoster ophthalmicus who did not respond to conventional treatment, and in whom the application of various nerve blocks and patient-controlled analgesia produced moderate pain relief. The patient died twenty days later due to cardiopulmonary failure.

• Journal of Hospice and Palliative Care
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• 제15권2호
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• pp.77-87
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• 2012

목적: 이 연구는 선호 음악 감상이 말기암환자의 통증 정도에 따른 정서 및 스트레스에 미치는 효과를 파악하고자 함이다. 방법: 이 연구에 참여한 대상자는 경상북도 선린병원의 호스피스 완화의료 병동에 입원한 18세 이상의 말기암환자 20명이었으며, 대상자들에게 자신이 선호하는 음악을 선택하도록 하여 각 회기 당 30분씩 총 6회 제공하였으며, 실험 전후, 사전사후 조사를 하였다. 연구 도구로는 통증 자각 척도 중 숫자 통증 등급(Numerical rating scale, NRS), 정서상태 측정 설문지, 스트레스 설문지를 사용하였다. 통증인식 수준에 따른 집단 간 차이를 비교하기 위해 실험 전 자가 통증 척도에 따라 두 집단(통증 점수가 5점 이하인 집단과 통증 점수가 6점 이상인 집단)으로 나눈 후, 주 2회로 매 1회 당 30분씩 총 6회 실험하였다. 매 회기 사전사후 정서 변화를 측정하였고, 1회기 전과 6회 후 스트레스를 측정하였다. 정서 변화와 스트레스는 대응 2-표본 비모수 통계 처리하였고, 추가 분석으로 정서 변화 검사에서 1회기 전과 매회기 후를 반복 측정 분산 분석으로 처리하였다. 결과: 정서상태 변화를 위한 사전사후 검증에서 유의한 차이가 나타났고(P<0.001), 스트레스도 감소된 것으로 나타났다(P=0.001). 두 집단은 통증 인식 수준이 달랐지만 음악치료중재를 통해 모든 대상자들은 정서상태 변화와 스트레스 감소 효과를 나타냈다. 결론: 본 연구 결과들은 선호 음악 감상이 호스피스 완화의료 병동에 입원한 말기암환자들의 통증인식 정도 차이에도 불구하고 두 집단 모두에게 정서와 스트레스를 긍정적으로 전환하기 위한 효과적이고 적절한 중재임을 보여준다.

• Journal of Hospice and Palliative Care
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• 제14권4호
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• pp.212-217
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• 2011

목적: 본 연구는 완화의료 활성화 및 서비스 질 향상이라는 정책적 목표를 위하여 2005년부터 완화의료 전문기관에 지원된 운영비가 구체적으로 어떻게 사용되고 있는지 연도별, 지원 횟수별 그리고 종별로 현황을 파악하고, 지원사업의 효과성에 대해 평가하고자 하였다. 방법: 지원 대상 기관이 제출한 사업비 정산 보고서를 토대로 운영비의 비목별 사용 비율을 빈도분석 하였다. 연도별 추세를 파악하기 위해 선형회귀분석을 실시하였고, 지원받은 횟수별, 기관 종별에 따른 완화의료 전문 기관 운영비의 비목별 사용액에 차이가 있는지 알아보기 위해 추리통계방법인 Kruskal-Wallis Test와 Wilcoxon Rank-Sum Test를 이용하였다. 결과: 연도별 분석에서, 프로그램 운영비와 교육 훈련비 및 홍보비에 대한 지출 비율은 지속적으로 증가한 것으로 나타났다(P<0.001). 그러나 저소득층 지원비는 감소하는 추세를 보였다(P=0.024). 연도별 지원받은 횟수별 의료기관 종별에 관계없이 운영비의 절반가량을 인건비, 시설비, 장비비 등의 하드웨어 마련에 사용하고 있었다. 결론: 정부의 완화의료 활성화 지원사업은 장비와 시설 개선 그리고 서비스 질 향상을 위한 활동에 지원금이 꾸준히 사용되고 있음을 알 수 있다. 또한 당해 사업의 평가 기준이 기관의 운영비 사용 흐름에 영향을 주는 것으로 보이는데, 이에 따라 환자 가족을 위한 프로그램 운영과 전문가 교육 훈련에 대한 지출 비율이 늘어나고 있어 서비스 질 향상 위한 바람직한 변화로 보인다. 다만, 평가 기준 조정을 통해 감소하고 있는 저소득층 지원 비율을 향상시킬 필요가 있다고 판단된다.

• Journal of Hospice and Palliative Care
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• 제26권3호
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• pp.101-111
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• 2023

Purpose: This study aimed to identify levels of perception and performance of end-oflife care among nurses and to investigate correlations between perception and performance. Methods: This cross-sectional descriptive survey included 321 nurses from a tertiary hospital in Seoul, Korea. The participants had at least 6 months of work experience and had been involved in end-of-life care at least once, in either ward or intensive care unit settings. A structured questionnaire was utilized to assess their perception and performance of endof-life care. Results: The mean score for perception of end-of-life care was 3.23±0.34, while the score for performance of end-of-life care was 3.08±0.34. There was a significant positive correlation between nurses' perception of end-of-life care and their performance in this area (r=0.78, P<0.001). Conclusion: It is necessary to change perceptions regarding end-of-life care and to develop systematic and standardized education programs including content such as assessing the hydration status of dying patients, evaluating mental aspects such as suicidal ideation, and providing spiritual care for nurses working in end-of-life departments.

• 한국보건간호학회지
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• 제17권2호
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• pp.255-265
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• 2003

This study was conducted to provide a baseline data for hospice nurses to improve their practices for the spiritual wellbeing of their clients. Analysis of the spiritual wellbeing status of hospice patients was conducted from April 20 to June 20, 2002. A total of 59 cancer patients who admitted to hospice care units of one university medical center, and who have alert mental status were recruited for the study. Paloutzian and Ellison (982) spiritual wellbeing scale and Jungho Kang (996) scale, which was modified for the cancer patients, were used as the study instruments, ANOVA and T-test were applied using SPSS win 10.0 for statistical analysis. The results are as follows : 1. The mean spiritual wellbeing score of the hospice patients was $49.76(SD\pm7.95)$. When it was converted into 4 point scale, the mean score for the spiritual wellbeing was 2.49. The mean religious wellbeing score was $24.17 (SD\pm5.56)$ and that of the existential wellbeing was $25.59 (SD\pm3.10)$. 2 The mean score for the total spiritual wellbeing was $52.54 (SD\pm8.12)$ for female, and $47.86 (SD\pm6.95)$ for male and the difference was statistically significant (t=-2.305, p=.025), 3. In testing the spiritual wellbeing, there was significant difference according to the religion (F=28.931, p=.000). 4. In testing the religious wellbeing, the mean score was $22.77 (SD\pm5.35)$ for male, and $26.20 (SD\pm5.32)$ for female and the difference was statistically significant (t=-2.430, p=.019). 5. In testing the religious wellbeing, there was significant difference according to the religion (F=37.522, p=.000). However, the religious wellbeing was not different according to the age, occupation, marital status and education level. 6. In testing the existential wellbeing. there was significant difference according to the religion (F=8.147, p=.000). However, mean score for the existential wellbeing was not significantly different according to sex, age, occupation, marital status and education level. 7. In testing the existential wellbeing, there was significant difference according to the level of vigor (F=3.662, p=.032), while no difference was observed in the existential wellbeing according to the general health status, degree of pain, and diagnosis. From the results described above it can be concluded that : To improve the spiritual wellbeing status of hospice patients, hospice nurses should identify spiritual needs of the patients according to the religion. gender and the level of vigor.

• 동서간호학연구지
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• 제19권1호
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• pp.7-14
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• 2013

Purpose: The purpose of this study is to compare the effect of aroma hand massage with hand massage without aroma on well-being of hospice patients. Methods: The design of this study is a quasi-experimental design. Data collection was conducted from May to December, 2012. Sixteen subjects were participated in the experimental group (aroma hand massage) and thirteen were paticipated in the control group (hand massage without aroma). The essential oil for aroma therapy was composed with 1% of Lavender and Bergamot. The aroma hand massage for the experimental group and hand massage for the control group were provided at 9 pm once a day for five days in a row. Subjects' characteristics and well-being were measured. To test the effect of aroma therapy a t-test was used with SPSS WIN 18.0. Results: There was no difference on well-being between aroma hand massage only group and hand massage group (t=1.90, p=.068). Conclusion: To develop aroma therapy to improve well-being for hospice patients, does not show that hand massage with aroma oil is superior them hand massage only for hospice patients. we recommend further studies to consider patients' preferences to aroma essential oil, aroma concentration and the time to provide aroma therapy need to be assessed.