• Journal of Hospice and Palliative Care
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• v.9 no.2
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• pp.106-111
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• 2006

Purpose: In terminal cancer patients, pain control with narcotic analgesics and supportive care by hospice are very useful treatment modality. However, many patients and their caregivers are poorly compliant in using narcotic analgesics for fear of addiction and tolerance. And also many patients and family caregivers are reluctant to accept hospice, presuming that hospice means patient's condition is no longer reversible and progressively deteriorating. The purpose of this study was to evaluate and analyze the perception of using narcotic analgesics and hospice by family caregivers of terminal cancer patients who play a critical role in health care in Korean culture. Methods: A total of 54 terminal ranter patient's family caregivers participated in this study. Questionnaire consisted of 15 questions about narcotic analgesics and hospice. Results: The study revealed following results. 1) family caregivers who are not aware of hospice are more than half (56.7%). 2) 81.8% of family caregivers agreed that hospice care is beneficial to terminal cancer patients. 3) 85.1% of family caregivers were under financial burden. 4) 83.2% of patient complained pain in 24 hours. 3) while 88.5% of family caregivers believed that narcotic analgesics can control pair, 79.1% and 79.6% of them also believed that use of narcotic analgesics would result in addiction and tolerance, respectively. Conclusion: There still exist barriers to family caregivers in using narcotic analgesics for pain control. And also, terminal cancer patient's family caregivers have poor information about hospice. Therefore, educational intervention about narcotic analgesics by pharmacist and doctors are needed for proper pain control for terminal ranter patients. In addition, more precise information about hospice care should be provided for terminal cancer patients and their family caregivers.

• Journal of Hospice and Palliative Care
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• v.5 no.2
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• pp.94-100
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• 2002

Purpose : The system to refer terminally ill patients to palliative or hospice care which ultimately give them emotional, psychological, and social support hasn't been fully developed and organized yet in Korea. The controversies concerning the current referral system are being analyzed to present the improvements. Methods : The questionnaires were asked to be filled out by family members of the 76 patients by phone interview, who were referred from the Seoul National University Hospital between April, 2001 to March, 2002. They were referred to the 35 palliative and hospice care-giving institutes and hospitals which were given questionnaires by mail. Results : Of the 76 patient's family members, 47 family members accepted to answer the questionnaire. The first thing that influence to family to determine the referral of patient was solicitation of doctors or nurses (44%). And they were influenced by allowance for the other things such as convenience of patients (32%), convenience of caring family members (24%). In the course of determining of referred institutes, responders had considered at first their dwelling area, and then fame of institutes, the place which patent had wanted to spend last hours or which is suitable for patient's funeral service, and their financial condition. Thirty-eight the 47 responders answered that they had experienced difficulties in referral procedure. The worst among difficulties was unwanted discharge, and followings were lack of information about the referred institutes, concern about patient's suffering, resistance of patient and opposition of other family members, etc. Although they expressed dissatisfaction in referral procedure, most of them answered they had been satisfied with hospice care at referred institute after referral. Merits of referral which responders counted were patient's peace, caring family's comfort and reduced cost in order. Of the 35 referred institutes, 24 institutes' staffs responded mail questionnaires and sent to us in return. Except one responder, the rest approved the referral system and thought that referred patients had been satisfied with their hospice care. And they claimed that systemic support of the government is definitely necessary. The most difficult thing which responders experienced in care of referred patients was lack of information about patients. Besides, there were patient's financial problems, lack of understanding about their institutes of patients or family, and inconvenience of terminal cancer patient's pain control. Conclusion : The development and support of the organized referral system is needed to alleviate the troubles which patients, family members, and palliative or hospice institutes and hospitals have to face through the procedure of the referral.

• Korean Journal of Hospice Care
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• v.6 no.1
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• pp.24-31
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• 2006

Psycho-social-spiritual care should be included with comprehensive nursing care of cancer patient. Because of human being have four dimensions as physical, psychological, social and spiritual dimension and they do interactional relationship with themselves, others and God. So caregivers of cancer patient have to recognize what they have psycho-social-spiritual needs and have to consider how caregivers can combine these in comprehensive nursing care. Cancer patient will be experienced shock, feeling of crisis and fear of death and will be showed denial, anger, bargaining, depression, accept or give-up, hope, spiritual distress and spiritual needs to which help them to do some rituals or interactions according their religion. Loving attitude is essential of cancer patient care especially of psycho-social-spiritual care. Dr. Kim and her some colleques investigated about this and find out 10 concepts(Caring Behaviors) by Graunded Theory Methodology. They are Noticing, Participating, Sharing, Active Listening, Complimenting, Companioning, Comforting, Hoping, Forgiving, Accepting.

• Korean Journal of Hospice Care
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• v.8 no.1
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• pp.55-67
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• 2008

Purpose: This study was to test the effects of wholistic hospice nursing intervention program on pain and anxiety for in-patient of hospice palliative care unit. This study's design was one-group pre-post test quasi- experimental research. Methods: The subjects of study were 27 patients who were over 18 years old and admitted in hospice palliative care unit of S hospital in P city with agreement in hospice palliative care in their terminal disease. The experimental group subjects participated in holistic hospice nursing program took 120 minutes per session, a total of 1,200 minutes altogether for 10 sessions. The period of data collection was from April 6, 2004 to April 20, 2005. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. A Wholistic Hospice Nursing Intervention Program (named ‘Rainbow Program’) was used as a experimental tool in this study. This was developed by the authors. It was provided by interdisciplinary hospice team (nurses, medical doctors, social worker, pastors, art therapists, and volunteers). In addition, Korean Version of Brief Pain Inventory (BPI-K) by Young-Ho Yun(1998) was used to test degree of pain in physical aspect. And State-Anxiety Inventory was developed by Spielberger(1975) and translated by Kim, Jung-Tack & Shin, Dong-Gyun(1978) was used to test the degree of state-anxiety in emotional aspect. Results: (1) Hypothesis No. 1 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of pain than before" was supported (t=-10.585, P= .000). (2) Hypothesis No. 2 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of state-anxiety than before" was supported (t=-8.234, P= .000). Conclusion: Our results testified that this Wholistic Hospice Nursing Intervention Program was effective to decrease pain and state-anxiety of the in-patients of hospice palliative care unit. Therefore it can be used and applied actively in practice as a useful model of interdisciplinary team approach by hospice professionals in hospice palliative care unit.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.55-66
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• 1990

This research is focused on the attitudes toward dying and hospice. 4subjects groups are Ca. patient, Ca. patien's family, elderly, medical personnel. A 40 questionare was filled out by each participant. For this study chi-square and T-test was done. The result were as follows : 1. Telling the truth 61.2% of all subject groups agreed upon telling the impending death. About 40% of elderly groups and cancer patient group were disagreed which is the highest percentage in all groups. Particularly medical personnel group were remarkably high in telling the truth. 2. Attitudes of medical personnels 43.3% of all groups agreed upon medical personnels prefer to avoid dying patient. In medical personnel group. 44% of respondents disagred comparably higher than other group. But 37.7% of medical personnel agreed. It showed that medical personnels admitted their negative feelings toward dying patient in considerable degree. 3. Attitudes toward mechanical assistance for life-expanding or hopeless patient. 44.8% of all groups disagreed upon mechanical assistance for hopeless case. Elderly (54.9%) and medical personnels (50%) disagreed, which is higher than cancer patient (33.3%) and (22.8%) of cancer patient's family. 4. Special facility and educational preperation for dying patient. 67.4% of all groups agreed upon the needs of special facility for dying, 81.3% of medical personnels agreed which is highest percentage in all group. 5. Attitudes of family members of dying patient. 82.3% of all groups agreed upon the family members feel annoyed at dying patient. 34% of cancer patient's family member and 48% of cancer patients group agreed, but elderly group showed highest percentage(84%). 6. Perception of dying patient about imminent death. 58.3% of all group thought dying patients are aware of their impanding death even though they had not beent told. 77.3% of medical personnel agreed which is highest percentage in all group.

• Journal of Hospice and Palliative Care
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• v.19 no.4
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• pp.292-295
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• 2016

Hospice and palliative care in Taiwan has been growing continuously. The 2015 Quality of Death index, as rated by the Economist Intelligence Unit, ranked Taiwan first among Asian countries and sixth in the world. In this review article, we highlight three particular areas that might have contributed to this success; the laws and regulations, spiritual care and research network. Finally, we discuss the future challenges and prospects for Taiwanese encounters. A systemic review was conducted with the keywords "hospice palliative care Taiwan" using PubMed. The passing of the "Natural Death Act" in 2000 set the example and established a landmark for patient autonomy in Asia; it guarantees the patient's right to request that medical staff do not resuscitate (DNR) them and to reject other futile medical treatments at the end of their life, thus reflecting the importance of palliative care from the policy perspective. In 2015, Taiwan passed another pioneering law entitled the "Patient Autonomy Act". This law states that a patient may decline medical treatment according to his/her own will. Taiwanese indigenous spiritual care was launched in 2000. It requires a Buddhist Chaplain to successfully complete a training program consisting of lectures, as well as bedside practicum before applying Buddhist practices to end-of-life care. The Japan-Korea-Taiwan research network was established for the purpose of enabling collaborative research for the East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED) cohort. With consensus from the government and society to make it a priority, hospice and palliative medicine in Taiwan has been growing steadily.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.7 no.2
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• pp.287-300
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• 2000

The purpose of this study was to identify nursing needs for hospice patients and their families in order to establish a foundation for appropriate Korean hospice care. To achieve the purpose of this study, 1 interviewed 50 patients who were going to die within 3 or 6 months and 42 family members of these patients who were registered in Pusan National University Hospital Hospice Program. The interview was done in the patient's room using semi-dialog style questionnaire. Data collection was done from March 1, 1999 to September 30. 1999. The important results of this study are summarized as follows : 1. Nursing needs that patients and their families have experienced were classified into six nursing domains; physical, emotional, economic, educational, spiritual and postmortal care. 2. Nursing needs of hospice patients are; pain control(80%), physical comfort(72%), consideration from medical personnel(68%), provision of information(64%), best treatment(60%), help of volunteers(36%), and continuous hospital treatment(32%). 3. Nursing needs of the families are; pain-control in Patients(97.6%), best treatment(97.6%), physical comfort of patients(95.2%), continuous hospital treatment(92.8%), provision of information(80.9%), consideration from medical personnel(76.1%), expectation of recovery(66.6%), emotional support of family(61.9%), and physical comfort of family(40.4%). It is concluded that there is a real difference between the nursing needs of patients and the nursing needs of their families. Therefore we must examine and intervene for the demands of patients and their families using a holistic approach in order to meet their hospice needs.

• Journal of Korean Academy of Nursing Administration
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• v.14 no.2
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• pp.182-195
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• 2008

Purpose: Hospice care represents all meaningful aspects of physical, mental and economical status of the end stage patients. The purpose of this study was to estimate the cost of home-based hospice care. Method: Fifteen nurses participated in counting an hour for requirement and home visit data of 50 end stage patients were analyzed. The method of to estimate the cost of home-based hospice care was three ways. Result: In case, including traffic expense, Singles fixed fee per visit via direct inquiry was 112,970 won but in case, excluding traffic expenses, was 86,036 won and traffic expenses per visit was 26,934 won. Final cost of home-based hospice care integrated the fixed fee per the needed time for visit and fee-for services. The fixed fee per 30 minutes was 35,251 won and 60 minutes was 46,595 won and 90 minutes was 57,939 won. We included pain management and the management of emergency and bereavement care among fee-for services. Conclusion: The cost of hospice care should be establish for not only patient but the living spouse, families, and children of the dying and for anyone else affected by any patient's death.

• Korean Journal of Hospice Care
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• v.7 no.2
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• pp.15-25
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• 2007

The purpose of this study was to survey the hospital staff's perception of hospice and death and thereby, suggest the ways to help them have a mature attitude towards and a better understanding of death through an effective education on hospice. For this purpose, this study was designed to provide some data useful for the hospital staff not experienced in facing the dying patients to handle the desperate situation skillfully and engage themselves more effectively in their hospice services. For this study, the researcher conducted a questionnaire survey for the staff of 'C' hospital in Seoul about their hospice philosophy, attitudes towards hospice and perception of death for the period from February, 2006 to March, 2006. A total of 751 subjects responded effectively to the survey. The data collected were analyzed using the SF55 11.0 for ANOVA and T-test in order to test the relationships among subjects' perception of death, their demographic variables, their health condition, their hospice philosophy formed from their experiences of patients' death and hospice services and their attitudes towards hospice. Besides, the correlations among their hospice philosophy, perception of death and attitudes towards hospice were tested. The results of this study can be summarized as follows; First, as a result of testing the relationships among subjects' experiences of health consulting. their experiences of patients' death and hospice and their hospice philosophy, it was confirmed that their experiences of health and death consulting and their experiences of having been educated were relevant. Second, it was found that such variables as health condition, death, experience of hospice and attitude towards hospice were not significantly correlated with each other. Third, as a consequence of testing the relationships among health condition, death, experience of hospice and perception of death, it was disclosed that only the physical health condition was significant. Fourth, it was confirmed that subjects' hospice philosophy, perception of death and attitudes towards hospice were at the usual level on average. Fifth, hospice philosophy, perception of death and attitudes towards hospice were found correlated significantly with each other. Sixth, as a result of the stepwise variable adjustment for such variables as hospice philosophy, perception of death, attitudes towards hospice, it was found that the adjusted r-square value was 0.347 when departments, experience of having been requested by dying patient for consulting, experience of having been educated on hospice, religion and marital status were set as independent variables. And the estimated value of each variable was found significant. Seventh, as a consequence of conducting the multiple regression analysis by setting 'religion' as significant independent variable, it was found that the estimated value of physical health condition was not significant statistically. This, as a result of the simple regression analysis for 'religion' only, its explanatory power was found .197, while its adjusted r-square value was 0.20. Eight, it was found that subjects' attitude towards hospice was significantly correlated with such variables of experience of patient's or relative's death, experience of having been requested for consulting about death, gender, marital status and departments. As a result of the multiple regression analysis and the subsequent stepwise adjustment for this variable, it was found that only 'experience of having been requested for consulting' had some explanatory power: its adjusted r-square value was 0.089. As discussed above, this study tested the correlations among various variables including hospital staff's attitude towards hospice and perception of death and thereby, provided for the data useful for their education on hospice. This study may be significant in that it proved that it would be essential to educate hospital staff on hospice for more effective care of hospice patients and their family members at hospital.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.232-237
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• 2004

Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.