• Journal of Physiology & Pathology in Korean Medicine
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• v.19 no.6
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• pp.1681-1684
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• 2005

Gastric cancer is the most common disease which is the highest genetic rate, chemotherapy is the only known way to treat, especially advanced gastric cancer. Although, it is the remedy, the harmful side-effects are an obstacle of the sustaining treatment and negative effect on immunologic ability of patients prologed. Consequently, it is surely necessary that effective control for sequele of anti-cancer treatment, and remedy which can improve the quality of patients life. 1, the writer, medicate patients, diagnose as gastric cancer in 4th stage, with Sohap-hyangwon and Chungwoolhyadamjen who complained of pain in sequele of anti-cancer treatment. The size of the metastastic liver tumor is decreasing in patients and the immunologic abilities are maintaining stable. This clinical cases are shown that the oriental medical care in long-term can improve the quality of life of the patients who has sequele of anti-cancer treatment.

• Journal of Hospice and Palliative Care
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• v.15 no.1
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• pp.30-35
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• 2012

Purposes: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. Methods: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. Results: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. Conclusion: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.

• Journal of Hospice and Palliative Care
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• v.22 no.2
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• pp.67-76
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• 2019

For hospice palliative care that provides comprehensive and general care, it is necessary to use assessment tools to objectively list issues and detail care plans. The initial assessment is a process of establishing an overall direction of care by identifying the patient's symptoms, social and spiritual issues and palliative care needs on the admission day or within one day of admission. This process is also used to identify the patients' and families' awareness of the illness, prognosis, treatment options and if the Physician Orders for Life-Sustaining Treatment (POLST) has been drafted. Consisting of 13 simple questions regarding the physical, mental, social, and spiritual domains, the Needs at the End-of-Life Screening Tool (NEST) is recommended as an initial assessment tool. Using specific assessment tools, a care plan is established for the issues identified in the initial assessment within three days of admission. A multidisciplinary assessment tool can be helpful in the physical domain. The psychosocial domain evaluates psychological distress, anxiety and depression. The social domain examines an ability to make decisions, understanding of the socioeconomic circumstance, family relationship, and death preparedness. A spiritual evaluation is also important, for which the Functional Assessment of Chronic Illness Therapy-Spiritual WellBeing Scale (FACIT-Sp) or the Spiritual Health Inventory (SHI) can be used. The use of an assessment tool could not only contribute to pain mitigation a better quality of life for patients, but also provide systematic training for a multidisciplinary team; And the process itself could be a stepping stone for the better care provision.

• Journal of Hospice and Palliative Care
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• v.23 no.3
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• pp.126-138
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• 2020

Purpose: In Korea, since the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life was implemented in February 2018, advance directives (ADs) have become legally effective and should be documented after sufficient explanation by a registered counselor. However, little is known regarding the adequacy of current AD counseling. This qualitative study aimed to explore the barriers to AD counseling based on counselors' experiences. Methods: We conducted focus group interviews using purposive sampling. Seven counselors working at hospitals, community health institutions, and non-profit organizations participated in this study. They were asked about the challenges and problems they encountered during AD counseling. Results: Three themes emerged from this study; 1) issues regarding consistency in AD counseling, 2) issues regarding AD counselors' competency and work environment, and 3) issues regarding the adequacy of the service system. The interviewees stated that the lack of a manual for standardized service made AD counseling inconsistent. The limited competency and poor work environment of counselors were pointed out as major barriers. The interviewees also stated that a proper service system considering individual circumstances is absent. Conclusion: The goals of AD counseling should be clarified and guidance should be implemented for providing standardized services. Further efforts to enhance the competency of AD counselors and to improve their working conditions are needed. Establishing an integrated framework for an adequate service system is also essential to overcome systematic barriers to AD counseling.

• Journal of Hospice and Palliative Care
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• v.25 no.4
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• pp.198-203
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• 2022

Purpose: To grasp public opinion accurately, we conducted an opinion poll on beliefs and attitudes toward physician-assisted suicide (PAS). Methods: A randomized telephone survey ensuring a representative sample was conducted, 1,007 participants aged 18 years or older (response rate, 9.5%). Results: The main results are as follows: i) 61.1% of participants thought that the current social support system for terminally ill patients and their families is insufficient; ii) 60% of participants did not recognize the term "hospice and palliative care"; iii) 81.7% of participants would not like to receive life-sustaining treatment if there is no possibility of recovery; iv) 58.4% of participants would like to receive hospice and palliative care if they are diagnosed with a terminal illness; v) the priorities for dignified dying were preparing a support system to reduce the burden of care (28.6%), economic support including reduction of medical expenses (26.7%), expansion of hospice and palliative care services (25.4%), and legalization of PAS (13.6%); and vi) 58.3% of participants agreed that the expansion of hospice and palliative care should precede the legalization of PAS. Conclusion: Koreans currently want other efforts, including expansion of hospice and palliative care services, instead of the legalization of PAS.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.167-172
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• 2017

End-stage liver disease (ESLD) is a terminal condition of cirrhosis which cannot be treated without liver transplantation. Thus, it is natural for patients to consider hospice/palliative care (HPC). Since the recent legislation of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (Act No. 14013) in Korea, the practicality of this law has become an issue. The criteria for HPC should be defined with consideration to how the severity of each ESLD complication may vary by individual patients. Generally, patients qualify if they have an intractable condition despite aggressive treatment such as the hepatorenal syndrome, hepatic encephalopathy or variceal hemorrhage. However, the option of liver transplantation should be sufficiently discussed with patients and their families before making a decision on HPC. The evaluation of which ESLD patients should receive HPC should be based on a long-term doctor-patient relationship and sufficient objective data. Therefore, a multidisciplinary approach and mutual consultation among cirrhosis specialists and doctors with other expertise are essential to offer optimal and balanced treatments between liver-specific treatment and HPC. Discussed in this review are adequate criteria for HPC and special considerations for ESLD at the point of HPC.

• Journal of Hospice and Palliative Care
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• v.16 no.3
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• pp.166-174
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• 2013

Purpose: This study aims to identify factors that influence middle-aged men's attitude towards death. Methods: The study enrolled 204 middle-aged (range=40~59 years) male residents of Daegu in Korea. Using a structured questionnaire, data were collected in October 4~30, 2010. For data analysis, we used descriptive statistics, t-test, one-way ANOVA, Scheff$\grave{e}$'s test, Pearson correlation coefficient, and stepwise multiple regression with SPSS WIN 14.0. Results: Participants' attitude towards death significantly differed according to educational level, religion, volunteer activities, and perceived health status. Moreover, their attitude towards death was negatively correlated with life stress and depression and positively correlated with self-esteem, life satisfaction, and coping behavior. The factors influencing the attitude towards death were life satisfaction, daily stress, religion, and depression, which explained approximately 25.7% of the total variance. Conclusion: Middle-aged men perform a crucial role in our society, and their attitude toward death affects how they cope with a situational crisis such as a terminal cancer or withdrawal of life sustaining treatment. Therefore, it is necessary to develop and implement a support program for middle-aged men, which offers them with various strategies to better manage their daily stress and improve their life satisfaction and coping skills.

• Journal of Korean Academy of Nursing
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• v.29 no.6
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• pp.1403-1418
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• 1999

Nursing is a discipline that helps to understand human being, to mitigate pains in life by promoting and recovering health, and to study the basic principles in sustaining and preserving life. To understand man and thus to nurse, it is essential to take the way of life of the specific person, his/her ideas, and natural environment into consideration. This means, the temperament, geography, environment and society peculiar to Korea have formed its own culture distinguished from those of other people. Thoughts and philosophy develop as a products of the specific culture and society. Therefore, accurate understanding of the concepts of nursing in the traditional thoughts and philosophy is indispensible to define Korean nursing. Modern Korean nursing at first rooted in the westernized nursing and western nursing intervention has been applied ever since its introduction in the late 19th century under the paradigm of western natural science. However, Koreans in the past made use of alternative therapy which put its emphasis on the organic and holistic view of life as well as a means for traditional medicine and nursing. This alternative therapy has been largely ignored since the introduction of western medical science, and was considered something used only by the aged or the uneducated. Moreover, Health concerned practices and customary traditional therapy have been discarded in the clinical medicine as "unscientific" or "unsystematic". As described above, it is true that Korean nursing has developed in the quantitative aspect only adhering to western nursing intervention. Now it is the time to stop to hold ourself and to look back our past. To find and develop the originality of Korean nursing to cope with the globalization, it is necessary to rediscover nursing (alternative) therapy in Korean culture ignored so far. For this purpose, this study examines the oriental philosophy to explore alternative nursing theory now under development. Also it aims to present ways to apply alternative therapy to nursing education, research and clinical practices and ultimately to show the desirable direction of the nursing to go in the future. Yangsaeng theory of Taoism and Yin-yang, Oh-hang(five elements) and khi theory in Dongeuibogam which gave enormous influences on Korean medical culture and treatment together with Sahsang(four temperaments) emphasized in Dongeuisusebowon will be examined as conceptual framework. Concepts of nursing are categorized into views on each the universe, the human being and nursing. Views on human being is classified into subcategories of body, life, health, and disease. Also it emphasizes the necessity of including alternative therapy in nursing intervention. Views on the universe is classified into yin-yang, khi, and temperament. Nursing will be available anywhere and easily accessible with this new nursing intervention. Trying to give a new thoughts to all those traditional concepts and alternative therapy, this article suggests the necessity of developing original Korean nursing theory and nursing intervention.

• Journal of Hospice and Palliative Care
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• v.2 no.2
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• pp.109-113
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• 1999

Purpose : Because we don't have inappropriate health care system for the terminal cancer patients, there were abnormal behavior patterns of health care utilization. So, There were needs to develop the comprehensive care for terminal cancer patients. Increased attention is being paid to the futility of life-sustaining treatment and high cost of management of terminal cancer patients Materials and Methods : This study was performed on cancer patients, registered in 1996 Central Cancer Registry, who were as insured person of Korea Medical Insurance and died from January 1997 to June 1998. We studied the day of medical care and medical expenses of 151 cancer patients evaluable. Results : The mean day of inpatient care was 39 days, and the mean days of outpatient care was 14 days in study subjects. Mean expenses per day of medical care, day of inpatient, and day of outpatients care were 85,392 won, 105,908 won, and 40,173 won. 95% of medical expenses is paid to the general hospital, and 85% of medical expenses was paid for inpatient care. About half of all medical expenses in th last 6 months were incurred in the last 60 days of life, and about 30 percent were incurred in the last 30 days. Expenses of outpatients care increased between 6 month and 3 months, after which they decreased. Expenses of inpatients care increased during all last 6months Conclusion : The distribution or medical expenses during the last 6 months in our study is similar to the distribution of American Medicare costs. We need to study medical expenses during the last year of life with large scale and details in order to develop the plan about the management of terminal cancer patient.

• The Korean Society of Law and Medicine
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• v.21 no.3
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• pp.117-144
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• 2020

In accordance with Article 15 of the Medical Law, medical personnel in Korea cannot refuse treatment of a patient unless there is a justifiable reason, and violation of this obligations is subject to criminal penalties. Japan also stipulates the same content in the law. However, this violation of obligations in Japan is not subject to criminal penalties, and is used as a judgment element of the liability for damages of doctors only in the case of damage to the patient. However, in both countries, it is difficult to interpret and apply the law because the regulation is a little ambiguous. In particular, the key is to find out what is the justifiable reason for the doctor to refuse treatment of the patient. Recently, Japan has completed the work of re-examining the discussion on medical refusal from a modern perspective in terms of improving the excessive working environment of doctors. On the other hand, in Korea, it is not clear in what cases it is possible to refuse treatment. because there is a lack of systematic discussion on medical refusal. Rather, unnecessary misunderstandings and controversies have resulted in the loss of trust between patients and doctors. In Korea, there is already a legal right for a doctor to reject it according to his religious beliefs or conscience in the implementation of the suspension of life-sustaining treatment decisions. And in the case of an abortion, debates are underway that doctors should be given the right to refuse it. This study introduces the current state of discussion in Japan, and examines the issues surrounding medical refusal in Korea. It is hoped that this study will facilitate further discussions on the medical refusal.