• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.42-49
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• 2022

As population aging increases the burden of cancer, the quality of death of patients with cancer is emerging as an important issue alongside their quality of life. To improve the quality of death, it is necessary to prepare for death, allowing patients to die comfortably and with dignity at the end. Considering these issues, I aim to discuss the practical aspects of notifying the patient of the terminal phase of cancer and planning for end-of-life care (i.e., advance care planning). When cancer treatment that can extend the patent's lifespan becomes difficult, the patient enters a treatment transition period. Treatment is shifted from life-prolonging care to life-enhancing care, and end-of-life care must be well planned. Medical providers often worry too much about whether the patient will be disappointed or psychologically traumatized when notified of the terminal phase of their cancer, thus delaying plans for end-of-life care. In fact, patients can accept their condition and prepare for end-of-life care better than we expect. During the treatment transition period, notification of terminal status should be given, and a well-prepared advance care plan should be established early when the patient has decision-making ability. In addition to conveying information, it is always necessary to be sensitive to whether the patient and caregiver understand the information and respond to their emotions.

• Journal of Hospice and Palliative Care
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• 제15권1호
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• pp.30-35
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• 2012

목적: 우리나라에서는 의과대학에서 말기환자 돌봄에 대한 교육이 충분치 못하다. 이 연구는 의과대학생에서 말기환자 돌봄 교육이 학생들의 말기환자의 돌봄에 관한 인식과 태도에 미치는 영향을 평가하고 교육에 대한 요구도를 파악하고자 하였다. 방법: 이화여자대학교 의학전문대학원 의학과 4학년 학생 166명을 대상으로 말기환자의 호스피스 완화의료에 관한 설문조사를 교육 전과 후에 조사하여 분석하였다. 결과: 사전의료의향서 작성시기에 관한 질문에 교육 전에는 '임종이 가까운 말기'가 33.6%로 가장 빈도가 높았으나 교육 후에는 '건강할 때'가 58.7%로 가장 많았다. 무의미한 연명치료의 유보나 중지에 관하여는 수업 전과 후에 심폐소생술은 48.1% 대 92.5%, 기관삽관이나 인공호흡기 38.3% 대 92.5%, 혈압상승제 39.1% 대 85.8%, 혈액투석 60.9% 대 94.8%, 총정맥영양공급 27.8% 대 56.0%로 유의한 변화를 보였다. 안락사에 대한 반대 의사는 46.6%에서 82.1%로 현저히 증가하였다. 모든 학생이 말기환자 돌봄 교육이 필요하다고 동의하였다. 결론: 대부분의 의과대학생은 임종환자관리 교육과정을 통해 죽음의 의미에 대해 성찰하는 시간을 갖고 말기환자의 호스피스 완화의료 교육의 필요성을 인식하였다. 또한 말기환자의 돌봄에 관한 인식과 태도의 변화가 컸다. 향후 이러한 교육과정이 모든 의과대학에서 정규교육과정으로 포함되어야 할 것이다.

• Journal of Hospice and Palliative Care
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• 제8권1호
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• pp.30-36
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• 2005

목적: 치료에 관계없이 뇌전이는 예후가 불량하다. 본 연구는 뇌 전이로 호스피스 완화의료를 받았던 환자를 대상으로 적절한 돌봄을 받았는지를 알아보고 임상적인 특성을 알아보고자 하였다. 방법: 2003년 3월부터 2005년 3월까지 본원의 호스피스 병동에서 뇌전이로 호스피스 완화의료를 받았던 40명의 말기 암환자를 대상으로 후향적으로 의무기록을 조사하였다. 결과: 대상자 중 남자 20명(50%), 여자 20명(50%)이며 연령의 중간값은 64세 였다. 가장 많은 암은 폐암으로 22명(55%)이고 다음으로 위암 5명(13%), 유방암 3명(8%) 순서였다. 원발암에 대한 전치료는 전혀 치료를 하지 않은 환자가 16명(40%)이고 항암치료는 20명(50%)를 받았다. 뇌전이 때의 증상은 두통 12명(30%), 의식변화 10명(25%), 국소 약화 9명(23%), 경련 4명(10%) 순서였다. 호스피스 병동의 입원 이유는 의식변화가 13명(33%)으로 가장 많았고 통증이 9명(23%)였다. 호스피스 완화의료를 받게 된 이유로 환자와 가족이 원한 경우가 14명(35%), 의사가 의뢰한 경우가 1명, 그 나머지 25명(62%)은 본원에서 보존적인 요법을 받던 중 호스피스 완화의료를 받게 된 경우이다. 호스피스 병동에서 입원기간의 중간값은 19일이었으며 호스피스 완화의료로 전원 후 생존기간의 중간값은 41일이었다. 뇌전이 진단 후 중간 생존기간은 87일이었다. 결론: 전이성 뇌암 환자의 호스피스 완화의료의 기간은 환자를 돌보기에는 충분하지 못하였다. 효과적인 호스피스 완화의료를 위해서는 의사와 환자, 가족에 대한 지속적인 호스피스 완화의료 교육과 홍보가 필요하리라고 생각된다.

• Journal of Hospice and Palliative Care
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• 제27권2호
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• pp.64-76
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• 2024

Purpose: End-of-life (EOL) care is a vulnerable period in an individual's life. Healthcare professionals (HPs) strive to balance the preservation of human life with respect for the patient's wishes. The aims of our study were to assess HPs' knowledge and perceptions of EOL care and to propose areas of improvement to improve the quality of care. Methods: We conducted a single-center, cross-sectional study involving HPs from a university hospital who encountered EOL care situations. We used a questionnaire divided into four sections: knowledge, practice, perception, and training. We calculated the rate of correct answers and the collective competence index. Results: Eighty-six questionnaires were analyzed, with 82.5% (71/86) completed by medical respondents and 17.5% (15/86) by paramedical respondents. Most of the respondents, 71.8% (51/71), were interns and residents. The study focused on palliative care, medical assistance in dying, aggressive medical treatment, and euthanasia, finding adequate knowledge in the first three areas. Respondents assigned to the intensive care unit and those with more than 8 years of experience had significantly higher correct answer rates than their counterparts. Seventy-five percent of respondents (65/86) reported feeling that they had little or no mastery of EOL care, primarily attributing this to insufficient training and the unavailability of trainers. Conclusion: Based on the findings of our study, which we believe to be the first of its kind in Tunisia, we can conclude that HPs possess an acceptable level of knowledge regarding EOL care. However, they require more exposure and training to develop expertise in this area.

• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.93-102
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• 2020

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

• 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.

• 한국호스피스완화의료학회:학술대회논문집
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• 한국호스피스완화의료학회 2008년도 하계학술대회
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• pp.19-21
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• 2008

Hospice movement in Taiwan emerged early in 1983. There was a nurse visiting terminal cancer patients by herself in Taipei city. It was ceased after one year. This stage of hospice movement might be called as "compassionate era". In early 1990, the first in-patient hospice ward was set up in north Taiwan. She demonstrated high touch in the high technology medical atmosphere. There was a great echo in Taiwan society to this action. In the following years, quite a few new hospice settings were founded. Medical professionals were aroused again to talk and think about life and death, dignity of dying and holistic care. This stage of hospice movement might be called as "ethical stage". Around 2000, obstructions were discovered in our development. We do need system and rules. Standard of setting and care, Curriculum of education and training, Accreditation system and specialist system and Nature Death Act are some of the systems we approached. This stage of hospice movement might be called as "Act stage". Among the "Act stage", the Nature Death Act is actually the mile stone in our history. What listed below are the translated one for the reference:

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.212-227
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• 2020

Purpose: This study presents the process of designing workbooks for advance care planning appropriate for the Korean cultural setting and describes actual case studies. Methods: This study focused on single inductive case studies of the utilization of an advance care planning workbook and recruited individual participants. Results: The workbook for adolescents contained six sessions and the workbook for children contained seven sessions. The workbook sessions led to four major discoveries: 1) considering the Korean cultural context, discussions on life and death must be held indirectly; 2) the role of the counselor as a supporter is crucial for the workbook to be effective; 3) the workbook must be accessible regardless of the seriousness of the illness; and 4) patients must be able to make their own choice between the workbook versions for children and adolescents. Six facilitating factors improved engagement: 1) the role of the counselor as a supporter; 2) building trust with the patient; 3) affirming freedom of expression on topics the patient wished to avoid talking about; 4) having discussions on what private information to keep secret and to whom the information can be disclosed; 5) discovering and regularly discussing relevant topics; and 6) regular communication and information-sharing with the patient's medical service providers. Conclusion: It is necessary to build on actual case studies regarding workbooks for children and adolescents in order to expand the usage of these workbooks to all relevant medical institutions in Korea.

• Journal of Hospice and Palliative Care
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• 제27권1호
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• pp.1-10
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• 2024

This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.

• Journal of Hospice and Palliative Care
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• 제17권4호
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• pp.289-300
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• 2014

목적: 본 연구는 말기아동 간호에 대한 교육자를 위한 교육프로그램인 ELNEC-PPC에 참여한 간호사의 소아청소년 호스피스완화의료(PPC)에 대한 지식 및 태도를 확인하기 위하여 수행되었다. 방법: 2012년 ELNEC-PPC 교육자를 위한 교육과정에 등록한 간호사 중 연구참여에 동의하고 서명날인 후 설문조사에 응답한 총 196명의 자료를 분석하였으며, 소아청소년 호스피스완화의료에 대한 지식과 태도는 20문항의 7점 척도로 측정하였다. 결과: 학력수준과 소아과병동 및 호스피스 근무경험에 따라 PPC에 대한 지식 정도에 차이가 있었다. 소아과 근무경험, PPC 경력 및 교육경험 이수 정도에 따라 소아 호스피스완화의료 태도에 차이가 있었으며, 기혼 간호사는 자녀의 완화의료서비스 결정에 대한 보호자의 권리에 대해 더 긍정적이었으며, 석사 이상군은 PPC에 대한 지식과 태도 정도가 높았다. 결론: PPC에 대한 간호사의 지식 및 태도를 높이기 위해서는 일반간호사를 대상으로 하여 표준화된 교육이 필요하다.