• 제목/요약/키워드: Hospice palliative medical care

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Life-Sustaining Treatment in End-Stage Liver Disease Patients: Patients' Decisions and Results

  • Jung, Hyun Jung;Park, Jeong Yun
    • Journal of Hospice and Palliative Care
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    • 제23권2호
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    • pp.85-92
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    • 2020
  • Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with end-stage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

말기암환자의 완화의료에 대한 의사들의 인식과 완화의료 의뢰 시 장애요인 (Doctor's Perception and Referral Barriers toward Palliative Care for Advanced Cancer Patients)

  • 이재리;이정권;황선진;김지은;정지인;김시영
    • Journal of Hospice and Palliative Care
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    • 제15권1호
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    • pp.10-17
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    • 2012
  • 목적: 완화의료를 위해서는 완화의료 대상자에 대한 판단을 하고 완화의료를 직접 시행하거나 완화의료에 자문/의뢰하는 의료인의 역할이 중요하다. 이에 본 연구는 한국의 암환자를 주로 진료하는 의사들의 완화의료에 대한 인식과 완화의료 의뢰 시 장애요인에 대해 알아보았다. 방법: 2010년 5월부터 6월까지 암환자를 주로 진료하는 전문의 477명을 대상으로 무기명 자기 기입식 웹 설문 조사를 수행하였다. 결과: 총 128명(26.8%)이 응답하였고, 설문에 응답한 모든 의사들은 말기암환자에게 완화의료가 필요하다고 생각하는 것으로 조사되었다. 80% 이상의 응답자들이 '3차 의료기관 및 암센터는 완화의료 서비스를 제공해야 한다.', '진행 암환자는 항암 화학요법을 받는 중이더라도 완화의료를 받아야 한다.', '말기암환자의 치료에는 여러 과의 협력이 필요하다.'에 동의하였다. 완화의료 수행능력에 대해서는 58% 이상이 자신이 하고 있는 신체 증상 조절 및 정신증상 조절, 말기암환자 가족의 정서적 지지에 만족한다고 응답하였으나 전반적인 말기암환자 및 임종 환자 관리 서비스는 64%에서 '만족스럽지 않다'고 응답하였다. 응답자 중 34명(26.6%)은 '자신의 말기암환자를 완화의료팀으로 자문'하거나 '의뢰한 경험이 없는 것'으로 나타났고 완화의료 의뢰의 장애 요인으로 '환자나 보호자의 거부'가 61명(47.7%)으로 가장 많았으며 다음으로 '믿고 의뢰할 수 있는 완화의료팀이 없어서'라고 응답한 의사가 59명(46.1%)으로 많았다. 결론: 본 연구에서 대부분의 암환자를 주로 진료하는 의사들은 말기암환자의 완화의료 시행에 대해 긍정적 인식을 가지고 있지만 실제 말기암환자 진료에 있어 다학제 간 협력이나 임종관리까지 충분한 완화의료의 제공은 이뤄지지 않는 것으로 나타났다. 효율적이고 수준 높은 말기암환자의 관리를 위해서 보다 적극적인 완화 의료 자문이나 의뢰가 시행되어야 할 것으로 생각된다.

Factors Affecting Psychological Burnout in Nurses Caring for Terminal Cancer Patients

  • Na-Ri, Seo;Hyun-E, Yeom
    • Journal of Hospice and Palliative Care
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    • 제25권4호
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    • pp.159-168
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    • 2022
  • Purpose: This study aimed to investigate the impacts of end-of-life care competency and ethical dilemmas on psychological burnout in nurses who care for terminal cancer patients. Methods: A cross-sectional study of 160 nurses who cared for terminal cancer patients was conducted. The participants were recruited from the hospice-palliative care wards, hematology or oncology wards, or intensive care units of three general hospitals in a single metropolitan area. Data were collected using a self-administered survey to assess end-oflife care competency, ethical dilemmas, psychological burnout, and general sociodemographic characteristics. Data were analyzed using descriptive statistics, the independent ttest, analysis of variance, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows (version 26.0). Results: Psychological burnout was significantly correlated with end-of-life care competency (r=-0.23, P=0.003) but not with ethical dilemmas. The results of the hierarchical linear regression analysis indicated that endof-life care competency (β=-0.280, P=0.010) and ethical dilemmas (β=0.275, P=0.037) were significant predictors of psychological burnout, after adjusting for age, religious status, clinical experience, and unit type. Conclusion: The current study's findings demonstrate that end-of-life care competency and ethical dilemmas are crucial factors that affect psychological burnout in nurses who care for terminal cancer patients. Substantive education programs must be developed to improve nurses' competencies in end-of-life care and ethical dilemmas to decrease psychological burnout.

호스피스 완화의료에서의 초기평가와 돌봄 계획의 수립: 평가도구를 중심으로 (Initial Assessment and Care Planning in Palliative Hospice Care: Focus on Assessment Tools)

  • 박은주;고수진;천재경
    • Journal of Hospice and Palliative Care
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    • 제22권2호
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    • pp.67-76
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    • 2019
  • 포괄적이고 총체적 돌봄을 제공하는 호스피스 완화의료의 경우 평가도구를 사용하여 문제목록의 객관화하고 돌봄 계획의 구체화하는 것이 필요하다. 초기평가는 입원 당일 혹은 1일 이내에 환자의 증상과 사회적, 영적 문제, 완화의료에 대한 요구가 무엇인지 파악하며 개괄적인 돌봄의 방향을 설정하는 과정이다. 현재 병에 대한 인식과 예후를 파악하는 것부터 연명의료계획서 작성까지 함께 검토한다. 초기평가도구로는 간단하지만 포괄적으로 신체적, 정신적, 사회적, 영적 영역을 아우르는 13개의 간단한 질문으로 구성된 NEST를 추천한다. 초기평가에서 파악된 문제에 대하여 구체적인 평가도구들을 활용하여 돌봄 계획을 수립하며 입원 후 3일이내 시행하는 것이 좋다. 신체적 영역의 경우 기능상태를 포함하여 통증과 비 통증 증상, 삶의 질을 함께 파악할 수 있는 다증상 평가도구가 도움이 될 수 있다. 환자의 증상은 단독으로 의미를 가지는 것이 아니라 복합적인 상호작용으로 발생하며, 그에 따라 포괄적으로 접근해야 하기 때문이다. 정신심리적 영역은 심리적 고통과 불안, 우울을 평가한다. 사회적 영역의 평가는 의사결정, 사회경제적 환경 파악, 가족 평가 및 임종 준비의 단계로 이루어진다. 영적 평가 역시 중요한데 FACIT-Sp나 SHI를 사용할 수 있다. 평가도구를 활용하는 것은 환자의 고통을 경감시키고 삶의 질을 향상시킬 뿐 아니라 의료진이 체계적으로 훈련되는 방안이 될 수 있으며 그 과정 자체가 더 나은 돌봄 제공을 위한 발판이 될 수 있다.

간호학부 졸업시점에 갖추어야 할 말기 환자간호 역량 (Palliative Care Competencies Required of Undergraduate Nursing Students in Korea)

  • 김현숙;강경아;김상희;김예진;유양숙;유수정;이명남;정연;권소희
    • Journal of Hospice and Palliative Care
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    • 제22권3호
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    • pp.117-124
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    • 2019
  • 2014년 세계보건협의회(WHO)가 채택한 결의에 따르면, 완화의료를 일상적 의료체계 내에 통합하기 위해서는 모든 간호사가 말기 환자를 간호할 수 있는 역량을 갖추어야 한다. 본 종설에서는 한국호스피스 완화의료학회 산하 한국호스피스완화간호 연구네트워크(KHPNRN)가 외국의 말기 환자간호 역량 개발 및 역량기반 교육 개발 사례에 대한 검토를 기반으로, 우리나라 실정에 맞게 개발한 말기 환자간호 역량을 소개하였다. 이는 역량 기반 말기환자간호 교육과정 개발을 위한 첫걸음이며, 앞으로 이 역량을 간호학부 교육과정에 통합하기 위한 적극적인 노력이 필요하다.

의료인의 호스피스가정간호에 대한 지식과 태도 조사연구

  • 김옥겸
    • 호스피스학술지
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    • 제2권2호
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    • pp.28-48
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    • 2002
  • The advances of medical technologies have not only prolonged human life span, but also extended suffering period for the patients with incurable medical diseases. Hospice movement was developed to help these patients keep dignity and lives peaceful at the end of their life. Since many patients prefer to spend the last moment of life at home with their family, hospice home care has become very popular worldwide. The purpose of this study for a promotion and development of hospice home care in Korea, and features basic research on medical profession's knowledge and attitudes to hospice home care. This study which was used for the research questionnaires developed by the researcher that were answered by 100 physicians and 127 nurses in a general hospital. Data were collected from April 22, 2002 to May 10, 2002. The SPSS was used to make a comparative analysis of the frequency, percentile, ANOVA, and x2-test. The results of the study were as follows; 1.The medical profession showed high level of knowledge of the definition and philosophy of hospice. However, the physician group of the examinees showed insufficient knowledge of the fact that hospice care includes bereavement care, while the nurse group's response to the same question showed a significant difference(x2=10.752, p=.001). 2.For whom the hospice home care is provided, 95.6% of the respondents showed very high level of knowledge as answering that the incurable terminal illness patients and their families are the beneficiaries of hospice care. The respondents counted nurses, volunteers, pastors, physicians and social workers, consecutively, as hospice care providers. More nurse were positive toward pastors than physicians in regarding as a hospice care provider by a significant difference(x2=11.634, p=.001). 3.For when to referral hospice home care to the patients, only 34.2% answered that patients with less than 6 months of survival time are advised to receive hospice care, reflecting very low level of knowledge. 23.0% of the physicians and 48.0% of the nurses answered that hospice care should be provided when death is imminent, making a significant difference between the two groups(x2=6.413, p=.000). 4.To promote hospice activities, 87.2% pointed out that it is crucial to make general people, including those engaging in the medical field, more aware of hospice. 79.7% answered that a national hospice management should be developed, marking a significant difference between the physician group and nurse group(x2=10.485, p=.001). 5.Advantages of hospice home care are 87.2% responded that patients can have better rest at home receiving hospice home care. Economical merit was brought forward as one of the advantages also, where there was a significant difference between the physicians group and nurse group(x2=7.009, p=.008). 6.The medical professions' attitude to hospice home care are 92.8% of the physicians answered that they would advise incurable terminally ill patients to be discharged from hospital, with 44.3% of them advising the patients to receive hospice home care after leaving the hospital. From the nurses' point of view, 20.9% of the terminally ill patients are being referred to hospice home care after discharge, which makes a significant difference from the physicians' response(x2=19.121, p=.001). 7. 30.6% of physicians have referred terminally ill patients to hospice home care, 75.9% of whom were satisfied with their decision. Those physicians who have never referred their patients to hospice home care either did not know how to do it(66.7%) or were afraid of losing trust by giving the patients an impression of giving up(27.3%). 94.9% of the physicians responded that they would refer their last stage patients to a doctor who is involving palliative care. 8.Only 36.2% of nurses have suggested to physicians that refer the terminally ill patients discharged from the hospital to hospice home care. Once suggested, 95.8% of the physicians have accepted the suggestion. Nurses were reluctant to suggest hospice home care to the physicians, as 48.8% of the nurses said they did not want to. From the result of this study the following conclusion can be drawn, the medical profession's awareness of general hospice care has been increased greatly compared to the results of the previously performed studies. However, this study result also shows that their knowledge of hospice home care is not good enough yet. There is a need for high recommended that medical education institute and develop regular courses on various types of hospice care. Medical field training courses for physicians and nurses will be very helpful as well. It is also important to train hospice experts such as palliative physicians and develop a national hospice management urgently in order to improve the hospice care in Korea.

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End-of-Life Issues in the Era of the COVID-19 Pandemic

  • Ghosh, Deyashinee;Gupta, Bhavna
    • Journal of Hospice and Palliative Care
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    • 제23권3호
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    • pp.162-165
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    • 2020
  • Purpose: The coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill and has exposed the lack of preparedness of most nations' health care systems. Even in usual times, palliative care has not received its fair share of recognition as an important component of patient care; instead, the emphasis is often placed on aggressive patient management. Now, with the entire medical community and decision-making committees focussed on intensive patient care, end-of-life care has taken a backseat. Methods: This article is a brief communication. Results: COVID 19 infection has been shown to lead to greater mortality and morbidity in patients with pre-existing illnesses such as hypertension, diabetes, renal failure, and cancer. Patients typically in need of end-of-life care, such as those with late-stage cancer or heart failure, are therefore at a higher risk of both contracting COVID-19 and suffering a more severe disease course. The strict nationwide lockdowns being imposed in most countries have deterred patients from seeking medical attention or hospice care. Every day new research is coming to light regarding COVID 19. This has helped significantly in creating awareness and limiting the spread of disease. However, misinformation is also rampant, leading to discrimination and mistreatment of infected patients. Conclusion: This pandemic has been a terrifying ordeal for all and has exposed our entire population physically, psychologically, emotionally, and financially to unimaginable stresses. In the present scenario, EOL care is as much a necessity as intensive care and should be given at least a fraction of its importance.

호스피스.완화의료 환자에게 적용한 방사선 치료의 부작용과 대처법 (The Adverse Effects of Radiotherapy and Its Management in the Hospice and Palliative Care Patients)

  • 이순신;박영진;한성호;박주성
    • Journal of Hospice and Palliative Care
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    • 제14권2호
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    • pp.61-70
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    • 2011
  • 최근 암 발생의 증가와 그에 따른 방사선 치료의 증가로 방사선 치료의 부작용은 암환자에서 치료 후 고려되어야 할 중요한 부작용 중 하나이다. 방사선 치료의 후기 부작용의 위험성이 있는 장기 암 생존자가 재발하여 호스피스 완화의료를 받게 되거나 말기암환자가 완화 목적의 방사선 치료를 받게 되는 경우 방사선 치료 부작용에 대한 이해와 지식이 이들 환자에 대한 의학적 진단 및 관리와 조정에 도움이 될 수 있을 것이다. 암환자의 생존율 향상과 암 치료 부작용의 감소를 위해 암 치료에 대한 많은 연구와 발전이 이루어지고 있지만, 임상에서 방사선 치료를 포함한 암 치료 부작용의 관리에 대한 관심은 상대적으로 적은 편이고 이에 대한 치료의 발전도 더디고 부족하다. 환자의 고통을 덜어주고 삶의 질을 유지, 향상시킬 수 있는 사후 관리를 위해 치료의 부작용과 관리에 대해 충분히 숙지할 필요가 있고, 향후 보완 통합적 접근으로 적극적인 연구와 관심이 필요할 것으로 생각된다.

호스피스케어와 전통적 의료서비스 이용간의 사망전 의료비용 비교 (Comparison of Medical Care Cost between Hospice Care and Conventional Care in the Last Year of life)

  • 최귀선;유창훈;이경희;김창엽;허대석;윤영호
    • 보건행정학회지
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    • 제15권2호
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    • pp.1-15
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    • 2005
  • The aim of this study was to compare medical cost of hospice care and that of conventional care during the last year of life, and identify factors that influenced the cost. From January to August 2003 592 terminal cancer patients receiving care from 5 hospice care units and 2 hospice care teams in general hospitals were enrolled to case group. Two hundreds and seventy two terminal cancer patients receiving conventional care from 7 general hospitals were enrolled to hospital-based control group, and 1,636 terminal cancer patients from 122 general hospitals located in same regions with the 7 hospitals were enrolled to community-based control. We used characteristics and medical cost from data of National Health Insurance Cooperation. Total medical cost per beneficiary in cases was about 10 millions won, 14.5 millions in hospital-based controls and 11.1 millions in community-based controls. The hospice care saved $45\%$ over the last year of life compared with hospital-based controls (p<0.0001). Saving of inpatient cost account for approximately $80\%$ of saving per beneficiary. Hospice care saved $29\%$ of medical cost per hospitalization day compared with hospital­based controls and $17\%$ compared with community-based controls (p<0.0001). Multiple regression analyses showed that hospice care significantly saved the medical cost. This study suggest that hospice care save medical cost compared with hospital-based control and community-based control. Most of saving of inpatient cost account for approximately $80\%$ of saving of medical cost.

Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment

  • Yu Mi Oh;Yoon Na Kang;Soo Jung Han;Jeong Hye Kim
    • Journal of Hospice and Palliative Care
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    • 제26권1호
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    • pp.7-17
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    • 2023
  • Purpose: The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). Methods: We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Results: Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. Conclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.