• Journal of Hospice and Palliative Care
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• 제24권2호
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• pp.116-129
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• 2021

Purpose: The purpose of this study was to examine the knowledge, caregiving performance, stress levels, and mental health of family caregivers of terminal cancer patients with delirium, insofar as these characteristics are relevant for delirium. Methods: Between May 1, 2019, and June 1, 2020, 96 family caregivers of terminal cancer patients with delirium completed a structured survey, the results of which were analyzed. Results: The average correct answer rate for delirium-related knowledge was 53.2% across all subcategories, which included knowledge of causes (41.5%), symptoms (65.4%), and caregiving (51.7%). The average score for family caregivers' performance of caregiving for delirium was 2.60±0.5, with subcategories including caregiving for patients without delirium (2.16±0.95), caregiving for patients with delirium (2.84±1.01), and stress related to caregiving for delirium (39.88±16.55), as well as categories such as patient-related caregiving (44.32±28.98), duty-related caregiving (44.21±30.15), and interpersonal relationship-related caregiving (22.35±25.03). For mental health, the average score among family caregivers was 1.96±0.70, with the highest score being for the category of additional items (2.28±0.84). Family caregivers of patients with hyperactive delirium as the delirium subtype had higher scores for caregiving performance than caregivers of patients with mixed delirium. Conclusion: Scores for the delirium-related knowledge and caregiving performance of family caregivers were low, while their caregiving stress levels were high due to their lack of knowledge and experience. This indicates the importance of delirium-related education for family members of patients with delirium and the necessity of developing nursing intervention programs to help manage stress and promote mental health among family caregivers.

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.183-197
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• 2020

Purpose: In this study, the researchers closely investigated the psychosocial problems faced by terminal cancer patients and their family members in hospice palliative care units. Methods: The investigators conducted four sessions of art therapy intervention programs for the terminal cancer patients and their family members, carried out in-depth interviews about the influence of the cancer experience on their family function and quality of life, and analyzed their experiences using grounded theory methodology. Results: After providing autonomous written informed consent, six pairs of terminally ill cancer patients and their family members, accounting for a total of 17 participants with the inclusion of additional family members who took part sporadically, took part in the art therapy intervention and interviews. The raw data, in the form of verbatim records, were analyzed according to the procedures of grounded theory (open, axial, and selective coding). Through these processes, a total of 154 concepts, 56 subcategories, and 13 categories were identified. Families were classified into four types according to their family function, quality of life, and attitude toward death. Though the art therapy intervention, patients and their family members experienced three stages over time. Conclusion: This research focused on essential aspects of the family relationships and the art therapy experiences of terminal cancer patients and their family members through an art therapy intervention in the context of hospice palliative care. Based on these observations, the researchers constructed a theoretical rationale for art therapy interventions delivered to patients and their family members in the process of hospice palliative care.

• 대한간호학회지
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• 제43권6호
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• pp.781-790
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• 2013

Purpose: The purpose of this study was to further understanding of the experience in acceptance of hospice by patients with terminal cancer and to explore the structure of this experience. Methods: A phenomenological methodology was used for the study. Participants were nine patients who were admitted to the hospice unit of a university hospital. In-depth interviews were done for data collection and the data were analyzed using Colaizzi's method. Results: Four categories, eight theme clusters and 18 themes were identified for the experience in acceptance of hospice by patients with terminal cancer. The three categories were 'Hope for a comfortable death', 'Overcoming barrier of prejudice about hospice', 'Incessant craving for life', 'The last consideration for self and family' Conclusion: While accepting the hospice care, participants experienced inner conflict between giving up medical treatments that prolong life and choosing a comfortable death, and also experienced an incessant craving for life. By accepting hospice care, they showed a human dignity that entails careful concerns for both self and family members.

• Journal of Hospice and Palliative Care
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• 제26권3호
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• pp.140-144
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• 2023

Many terminally ill cancer patients grapple with a range of physical, psychological, and social challenges. Therefore, it is critical to offer effective psychological interventions to assist them in managing these issues and enhancing their quality of life. This brief communication provides a concise overview of acceptance and commitment therapy (ACT), along with empirical evidence of its application for patients, caregivers, and healthcare professionals in hospice and palliative care settings and an overview of future directions of ACT interventions in South Korea. ACT, a third-wave type of cognitive behavioral therapy, is a model of psychological flexibility that promotes personal growth and empowerment across all life areas. Currently, there is substantial evidence from overseas supporting the effectiveness of ACT on health-related outcomes among patients with various diseases, caregivers, and healthcare professionals. The necessity and significance of conducting ACT-based empirical research in hospice and palliative care settings in South Korea are discussed.

• Journal of Hospice and Palliative Care
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• 제26권4호
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• pp.171-184
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• 2023

Purpose: The study explored the meaning of experiences within a family art therapy process among terminal cancer patients and their families. Methods: Ten participants, including four terminal cancer patients currently admitted to the hospice ward at an inpatient hospice facility in S City and four caregiving family members, engaged in four cycles of family art therapy sessions. The sessions were conducted weekly or bi-weekly, and each lasted approximately 50 minutes. Results: Nine cross-case themes emerged: "feeling unfamiliar and intimidated by the idea of expressing my thoughts through art," "trying to accept the present and positively overcome sadness," "expressing hope through emotional bonds during the process of parting," "conveying and preserving personal and family beliefs," "feeling upset about family imbalances caused by deteriorating health," "valuing togetherness and striving for stability amidst the current challenges," "art as a medium of empowerment for patients and facilitator of family conversations, even amidst difficulties," "sharing a range of emotions-not just joy, but concerns and sorrow-through art," and "gratitude for art' s role in improving family communication and connection through artwork. Conclusion: The findings of this study lead to several conclusions. First, patients and their families faced psychological challenges when confronted with impending death, yet they strove to remain optimistic by seeking meaning in their struggles. Second, families practiced open and expressive communication, sharing a spectrum of complex emotions with one another. Third, even as the patient's condition worsened, resulting in family fatigue, their support and cohesion strengthened.

• 호스피스학술지
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• 제2권1호
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• pp.21-40
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• 2002

Cancer is the second leading cause of the death in Korea. Family caregivers of dying patients manifest many psychological and physical symptoms of stress, and they often seek for informational support from health care providers. Unfortunately, however, few systematic studies identify the actual effect of such support on family caregivers. This study, thus, intends to evaluate the effect of informational support for hospice care. One group pretest-posttest design was used, employing the stress-coping model by Cohen and Wills as a conceptual framework. This research was conducted from July 1 to November 15, 1998, initially with 32 subjects sampled from hemato-oncology department of two general hospitals in Seoul, but reduced to 18 at the end due to the untimely death of patients or caregiver's refusal during the course of study. Informational supports were programmed to provide the family caregivers with 8 times of education and counseling as well as 24-hour hot-line for 4 weeks. A booklet that explains the various problems of hospice care was also prepared and distributed to all subjects. Data were collected by using self-report questionnaires and reviewing medical records. The tools used in this study were based on the Weinert's PRQ-II(scale of perceived social support), Spielberger's state anxiety inventory, and CES-D. Also included in the data collection were the general characteristics of family caregivers and patients, and the pain intensity and the performance status of patients. The data were analyzed with descriptive statistics, Wilcoxon sign rank test and paired t-test using SPSSWIN program. The results of the study were as follows: 1.The perceived social support of family caregivers was not significantly increased with informational support for hospice care(t=1.64, one tailed p=.060). 2.The anxiety of family caregivers was significantly reduced following informational support for hospice care(t=3.48, one tailed p=.002). 3.The depression of family caregivers was significantly reduced following informational support for hospice care(t=-2.18, one tailed=.022). 4.The pain intensity of patients with terminal cancer was significantly reduced following informational support for hospice care(t=-2.41, two tailed p=.027). The results suggest that the informational support provided to family caregivers of patients with terminal cancer reduced not only their anxiety and depression but also the pain intensity of patients. Further study is necessary to consolidate the conceptual framework of this study with expanded number of subjects. Nevertheless, it was certain that the informational support program for hospice care was very helpful to both caregivers and patients. Thus, the informational support program is strongly recommended for the hospitals which have no hospice unit yet.

• 호스피스학술지
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• 제3권2호
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• pp.1-11
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• 2003

Purpose: The purpose of this study was to find out the effect of hospice home care on the pain relief and quality of life of terminal cancer patients. Method: Experimental pre and post tests were provided to a single group to see the changes of quality of life of patients who were referred to a hospice home care department after having cancer treatment. They were visited at least 8 times for the duration of 4~6 weeks and were provided a 24 hour phone call service. 41 subjects were transferred to a hospice home care department after being discharged from hospital were selected. Result: 1)The first hypothesis that "the pain score of the subjects after receiving hospice home care would be different from before receiving hospice home care would be different from before receiving hospice home care" which scored 4.06 point at the first test and 3.41 at the second did not statistically show a significant difference(t=1.421 p=1.66), even though the pain score is decreased. 2)The 2nd hypotheses that "the quality of life score of the subjects after receiving hospice home care would be different from before receiving hospice home care" which scored 2.88 point at the first test and 3.39 at the second showed a significant difference(t=-6.759, p=.000) and was supported. Regarding the changes of quality of life score, social aspect(t=-5.745, p=.000), emotional aspect(t=-5.684, p=.000), and spiritual aspect(t=-6.889, p=.000) has significantly been increased, while physical aspect has been more decreased significantly than before the hospice home care is provided(t=4.282, p=.000). Conclusion: It was effective to provide hospice home care in relieving the terminal cancer patients' pain and in improving their quality of life, even though a short term hospice home care for 4-6 weeks was provided.

• Journal of Hospice and Palliative Care
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• 제24권3호
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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.

• 대한간호학회지
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• 제30권5호
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• pp.1156-1169
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• 2000

The study was aimed at developing an independent hospice center model that would be best suited for Korea based on a literature review and the current status of local and international hospices. For the study, five local and six international hospice organizations were surveyed. Components of the hospice center model include philosophy, purpose, resources (workers, facilities, and equipment), allocation of resources, management, financial support and hospice team service. The following is a summary of the developed model: Philosophies for the hospice center were set as follows: based on the dignity of human life and humanism, help patients spend the rest of their days in a meaningful way and accept life positively. On the staff side, to pursue a team-oriented holistic approach to improve comfort and quality of life for terminally ill persons and their families. The hospice center should have 20 beds with single, two, and four bed rooms. The center should employ, either on a part-time or full-time basis, a center director, nurses, doctors, chaplains, social workers, pharmacists, dieticians, therapists, and volunteers. In addition, it will need an administrative staff, facility managers and nurses aides. The hospice should also be equipped with facilities for patients, their families, and team members, furnished with equipment and goods at the same level of a hospital. represented by a center director who reports to a board and an advisory committee. Also, the center director administers a steering committee and five departments, namely, Administration, Nursing Service, Social Welfare, Religious Services, and Medical Service. Furthermore, the center should be able to utilize a direct and support delivery systems. The direct delivery system allows the hospice center to receive requests from, or transfer patients to, hospitals, clinics, other hospice organizations (by type), public health centers, religious organizations, social welfare organizations, patients, and their guardians. On the other hand, the support delivery system provides a link to outside facilities of various medical suppliers. In terms of management, details were made with regards to personnel management, records, infection control, safety, supplies and quality management. For financial support, some form of medical insurance coverage for hospice services, ways to promote a donation system and fund raising were examined. Hospice team service to be provided by the hospice center was categorized into assessment, physical care, emotional care, spiritual care, bereavement service, medication, education and demonstrations, medical supplies rental, request service, volunteer service, and respite service. Based on the results, the study has drawn up the following suggestions: 1. The proposed model for a hospice center as presented in the study needs to be tested with a pilot project. 2. Studies on criteria for legal approval and license for a hospice center need to be conducted to develop policies. 3. Studies on developing a hospice charge system and hospice standards that meet local conditions in Korea need to be conducted.

• Journal of Hospice and Palliative Care
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• 제3권1호
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• pp.18-27
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• 2000

목적 : 본 연구는 강남성모병원 호스피스 병동에 입원한 환자들의 입원 시 삶의 질과 간호서비스를 받는 동안 삶의 질 변화와 호스피스 간호서비스가 말기환자의 삶의 질에 미치는 영향을 알아보고자 시도하였다. 방법 : 1999년 10월부터 2000년 3월 사이에 가톨릭 대학교 강남성모병원 호스피스 병동에 입원한 환자와 가족 100명을 대상으로 연구자가 수정, 보완하여 개발한 설문지를 통해 자료를 수집하였고, 수집된 자료는 repeated measures ANOVA로 분석하였다. 결과 : 1) 간호제공자에 의해 인지된 환자의 삶의 질 평점은 입원시, 입원 1, 2, 3, 4주에 각각 3.31, 3.68, 3.56, 3.73, 3.75로 입원 당시보다 시간이 지남에 따라 유의하게 향상되었고, 입원시점에 따라 항목별로 살펴 볼 때 "신체적 청결"(F=6.50, P=0.0001) "통증조절"(F=18.01., P=0.0001) "대변상태"(F=2.96, P=0.0237) "수면상태"(F=3.99, P=0.0048) "메스꺼움/구토"(F=4.50, P=0.0022) "의료진의 편안한 돌봄"(F=3.95, P=0.0051) "가족들의 돌봄"(F=2.76, P=0.0317) "불안감"(F=3.14, P=0.0177) "마음이 편안함"(F=3.63, P=0.0085) "인간적인 대우"(F=3.32, P=0.0136) "죽음이 끝이 아니라 새로운 시작이라고 생각함"(F=2.54, P=0.0450) 등의 항목에서 유의한 차이가 있었다. 2) 환자 자신에 의해 인지된 삶의 질 평점은 입원 시와 입원 1주에 각각 3.63, 3.83으로 향상되었지만 유의한 차이는 보이지 않았다. 입원시점에 따라 항목별로 살펴볼 때 "통증조절" 항목만이 유의한 변화를 보였다. 3) 사망시점으로부터 삶의 질 평점은 사망 5주전, 4주전, 3주전, 2주전, 1주전에 각각 3.48, 3.51, 3.44, 3.46, 3.50이었으며 유의한 차이는 없었다. 결론 : 본 연구의 결과 호스피스 서비스는 말기 환자의 삶의 질에 긍정적인 영향을 주는 것으로 보여졌다. 따라서 호스피스 서비스의 질 향상을 위해 호스피스 환자들을 지지해 줄 중재방안을 모색해야 하며, 특히 간호의 영적 영역에 초점을 두어야 하겠다. 또한 말기 환자의 주관적인 삶의 질 측정을 위해 도구개발이 이루어져야 하며 대상자를 확대하여 계속적인 연구가 있어야 할 것으로 생각된다.