• Korean Medical Education Review
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• v.22 no.3
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• pp.146-152
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• 2020

Hospice and palliative care (HPC) education is an essential component of undergraduate medical education. Since February 4th, 2018, withholding and withdrawing life-sustaining treatment at the end of life (EOL) has been permitted in Korea as put forth by law, the "Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life." Therefore, Korean medical schools have faced a challenge in providing comprehensive HPC education in order to better prepare medical students to be competent physicians in fulfilling their role in caring for patients at the EOL. There have been considerable variations in the evolution and organization of HPC education across Korean medical schools for the past 20 years. In 2016, all medical schools taught HPC curriculum as a separate course or integrated courses, with the most frequently taught topics including: delivering bad news, pain management, and the concept of palliative medicine. However, the content, time allocation, learning format, and clinical skills practice training of HPC education have been insufficient, inconsistent, and diverse. For this reason, we propose a HPC curriculum containing seven domains with 60 learning objectives in a course duration of over 20 hours based on the Palliative Education Assessment Tool (PEAT) as standard HPC curriculum. Furthermore, we recommend development of a national curriculum for HPC/EOL care education to be organized by the HPC board and managed under the accreditation criteria of the Korea Institute of Medical Education and Evaluation.

• 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.5 no.2
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• pp.101-110
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• 2002

Purpose : With the elongation of the average life span, the main causes of death are chronicle illness including cancers resulting in a large amount of medical resources. And there are still many patients to whom a sufficient medical care is not given. All these bring on the uneven distribution of medical resources together with the increase of medical cost. Hence, an efficient system should be set up to solve these problems. Methods : The hospice draws a great attention as a resolution of high medical cost and uneven medical resource distribution, and has been proved to be an alternative to the existing medical system. So, the characteristics of the hospice has been reviewed, particularly with respect to its scopes and related resources. And by tracking the actual cases, the necessary services and supports are investigated. Results : The intrinsic characteristics of hospice is that it executes not only the medical exercise but also all the subjects related with patients and their families. And the hospice is performed not only by the medical experts but also by all the disciplines including social and spiritual affairs. This indicates that the hospice requires the integrated system comprised of medical, social and other welfare entities. Conclusion : To establish the actual hospice, an efficient and systematic integration of all the existing medical and other welfare resources in the local society is necessary. The most practical way is the networking of resources, which practices the hospice more efficiently without additional investment.

• Journal of Hospice and Palliative Care
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• v.24 no.4
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• pp.254-260
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• 2021

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.65-73
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• 2013

The objective of this paper is to suggest future goals and strategies for social work in hospice and palliative care in Korea by understanding its historical background. Both literature review and participant observation were performed to examine historical data relating to social work in hospice and palliative care in Korea. Also reviewed were the current trends with a focus on the roles of social workers in the said arena, qualifications, education, research and medical insurance policy. First of all, the roles of social workers do not appear to be clearly defined in the field of hospice and palliative care, which seems to lead to the lack of recognition as professional workers. The qualification standard for social workers in hospice and palliative care remains inadequate. Second, there seems to be insufficient professional social worker training resources, in terms of both the number of educators and training programs. Third, social workers in Korea produce significantly less publications than those in other professions. There is also a dearth of qualified evidence-based research that is needed to prove benefits of intervention and ultimately for policy implications. Last, the current medical insurance policy needs to be revised to secure fees for social work services and dedicated full-time social workers in hospice and palliative care. Korea needs to approach social work in hospice and palliative care with specific goals to develop future strategies. Related infrastructure and an executive structure should be established via networking and partnership with academic societies, associations and schools.

• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.99-108
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• 2016

Hospice palliative care (HPC) in Korea has developed steadily since its introduction in 1965. Currently, HPC in Korea is targeted only towards terminal cancer patients and their families, and the national health insurance scheme covers only inpatient hospice care for said patients. In recent years, healthcare professionals and policy makers began to recognize the need for HPC services in diverse settings including outside hospital boundaries, and for all terminally-ill patients. A law on HPC passed in January 2016 allows terminally-ill patients to refuse life-sustaining treatments, and will likely facilitate further development of HPC services. It is critical for the government and all interested parties in the medical, academic and social sectors to collaborate to ensure its success once it takes effect in 2017. This article will briefly review the half-century history of HPC in Korea, and discuss how to prepare for and cope with death and, thereby, improve the quality of death.

• Korean Journal of Hospice Care
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• v.8 no.1
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• pp.153-171
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• 2008

• Korean Journal of Hospice Care
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• v.8 no.1
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• pp.89-122
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• 2008

• Journal of Hospice and Palliative Care
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• v.24 no.2
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• pp.130-134
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• 2021

In the era of coronavirus disease 2019 (COVID-19), social distancing and strict visitation policies at hospitals have made it difficult for medical staff to provide high-quality end-of-life (EOL) care to dying patients and their families. There are various issues related to EOL care, including psychological problems of patients and their families, difficulties in EOL decision-making, the complicated grief of the bereaved family, moral distress, and exhaustion of medical staff. In relation to these issues, we aimed to discuss practical considerations in providing high-quality EOL care in the COVID-19 pandemic. First, medical staff should discuss advance care planning as early as possible and use the parallel planning strategy. Second, medical staff should play a role in facilitating patient-family communication. Third, medical staff should actively and proactively evaluate and alleviate dying patients' symptoms using non-verbal communication. Lastly, medical staff should provide care for family members of the dying patient, who may be particularly vulnerable to post-bereavement problems in the COVID-19 era. Establishing a system of screening high-risk individuals for complicated grief and connecting them to bereavement support services might be considered. Despite the challenging and limited environment, providing EOL care is essential for patients to die with dignity in peace and for the remaining family to return to life after the loved one's death. Efforts considering the practical issues faced by all medical staff and healthcare institutions caring for dying patients should be made.

• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.32-40
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• 2010

Purpose: The survey was aimed to provide basic data to develop a certification system for hospice and palliative care professionals. Methods: National Cancer Center (NCC) and the Korean Society for Hospice & Palliative Care (KSHPC) conducted the survey for hospice and palliative care professionals who worked at 34 Palliative care units designated by the Ministry of Health, Welfare, and Family Affairs (MW) and the members of the KSHPC. The survey was conducted via e-mail from June 17 to 23, 2009. Total 220 professionals were surveyed. Results: Most of the hospice and palliative care professionals reported a great need for certification system: Physician, 90% (n=51) nurse, 84% (n=134) social worker, 89% (n=35). In regard with the requirement for the certification, a majority of physicians (46%) preferreddiploma course, while social workers (46%) preferred training course for medical social workers. Concerning the certification body, physician (45%) preferred the KSHPC and the MW almost equally, while nurses (50%) and social workers (60%) preferred the MW highly. As for the body to develop and accredit advance training course for each professionals, most of the physicians (51%) preferred the KSHPC, whereas nurses and social workers preferred collaboration of the MW (or NCC) with the professional society, such as the KSHPC (23%), the Korean Hospice & Palliative nurses association for nurses (21%), or the Korean association of (medical) social workers (37%). Lastly, all respondents preferred the course format of once a week, full day, and some field study at weekend. Conclusion: Korean hospice and palliative care professionals identified the great need for the certification system, therefore, the adequate system development must be followed to reflect their voice.