• Journal of Hospice and Palliative Care
• /
• v.26 no.2
• /
• pp.69-79
• /
• 2023

Purpose: This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods: A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results: In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion: The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

• Journal of Hospice and Palliative Care
• /
• v.23 no.4
• /
• pp.172-182
• /
• 2020

Purpose: This study aimed to identify the relationships among attitudes towards death, perceptions of hospice care, and hospice care needs as perceived by family members of patients in the intensive care unit (ICU). Methods: This study used a descriptive correlational method. A structured questionnaire was used to collect data from 114 participating families in the ICU at Dong-A University Hospital, from October 10 to November 1, 2019. The data were analyzed in terms of frequency, percentage, and mean and standard deviation. The t-test, one-way analysis of variance, and Pearson correlation coefficients were also conducted. Results: Perceptions of hospice care showed significant differences according to age (F=3.06, P=0.031) and marital status (t=3.55, P=0.001). However, no significant differences in attitudes towards death or hospice care needs were found. A significant positive correlation was found between perceptions of hospice care and hospice care needs (r=0.49, P<0.001). Conclusion: In order for families to recognize the need for hospice care and to receive high-quality palliative care at the appropriate time, it is necessary to increase public awareness of hospice care through various educational and awareness-raising efforts, thereby providing opportunities for families of terminally ill patients to request hospice care.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.11
• /
• pp.4653-4658
• /
• 2015

Background: Palliative therapies have an important role in increasing the quality of healthcare and in dealing with physical and psychosocial problems due to cancer. We here aimed to evaluate the managerial perspectives and opinions of the hospital managers and clinical directors about specialized palliative care centers. Materials and Methods: This study was conducted in two large-scale hospitals in which oncology care is given with medical directors (n:70). A questionnaire developed by the researchers asking about demographic characteristics and professional experience, opinions and suggestions of medical directors about providing and integrating palliative care into healthcare was used and responses were analyzed. Results: Potential barriers in providing palliative care (PC) and integrating PC into health systems were perceived as institutional by most of the doctors (97%) and nurses (96%). Social barriers were reported by 54% of doctors and 82% of nurses. Barriers due to interest and knowledge of health professionals about PC were reported by 76% of doctors and 75% of nurses. Among encouragement ideas to provide PC were dealing with staff educational needs (72%), improved working conditions (77%) and establishing a special PC unit (49)%. An independent PC unit was suggested by 27.7% of participants and there was no difference between the hospitals. To overcome the barriers for integration of PC into health systems, providing education for health professionals and patient relatives, raising awareness in society, financial arrangements and providing infrastructure were suggested. The necessity for planning and programming were emphasized. Conclusions: In our study, the opinions and perspectives of hospital managers and clinical directors were similar to current approaches. Managerial needs for treating cancer in efficient cancer centers, increasing the capacity of health professionals to provide care in every stage of cancer, effective education planning and patient care management were emphasized.

• Journal of Hospice and Palliative Care
• /
• v.24 no.1
• /
• pp.46-55
• /
• 2021

Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Results: Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. Conclusion: The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

• Journal of Hospice and Palliative Care
• /
• v.25 no.2
• /
• pp.76-84
• /
• 2022

Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.2
• /
• pp.739-742
• /
• 2013

Background: This study was to evaluate the survival of patients with pleural and intraperitoneal malignant mesothelioma and to investigate the efficacy of chemotherapy (CT) as well as radiotherapy (RTH) and surgery compared to best supportive care (BSC). Materials and Methods: Forty patients with malignant mesothelioma (38 with pleural and 2 with intraperitoneal) were enrolled. Twenty seven patients underwent (CT) chemotherapy of which 2 also received (RTH) and surgery was only for biopsy in 15/40. Combination chemotherapy included cisplatin-gemcitabine, cisplatin-navelbine and cisplatin (or carboplatin) with premetrexed. Thirteen patients received only best supportive care. Results: A total of 12 (30%) patients were male, and 28 (70%) female. Median age was 54.0 years and the male/female ratio was 1/2.33 (P=0.210). Residential exposure played a major role in two regions, Helwan and Shoubra, in 20% and 15%, respectively. Overall mean survival time was $13.9{\pm}2.29$ months. That for patients who had received best supportive care was $7.57{\pm}1.85$ months, for chemotherapy was $16.5{\pm}3.20$ months, and multimodality treatment regimen $27{\pm}21.0$ months (P=0.028). Kaplan-Meier survival did not significantly vary for sex, residence and the pathological types epithelial, mixed and sarcomatous. The median survival for performance status and treatment modalities was significant (P=0.001 and 0.028). Best supportive care using opioids with a mean dose of 147.1 mg (range 0-1680) of morphine sulphate produced good subjective response and reasonable quality of life but did not affect survival. Conclusions: We conclude that CT prolongs survival compared to BSC in patients with malignant mesothelioma. Moreover, using escalating doses of opioids provides good pain relief and subjective responses.

• Korean Journal of Hospice Care
• /
• v.7 no.2
• /
• pp.6-14
• /
• 2007

Purpose: Hepatocellular carcinoma is the 3rd leading cause of cancer death in Korea and its prognosis is very poor. We aimed to investigate the clinical characteristics of terminal patients with hepatocellular carcinoma on admission into a hospice unit, and to know if they had received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 62 patients with hepatocellular carcinoma who had admitted, received palliative care, and died in a hospice unit between January 2003 and December 2005. Results: The median age of patients was 56.5 years with 50 men(80.65%) and 12 women(19.35%) and gender ratio(male to female) was 417. Child-Pugh class A, B, and C were 6(9.68%), 22(35.38%), and 34(58.84%) respectively. We divided the patients into two groups and compared, the terminal HCC patients with class C as group I and those with class A & B as group 2. The median time from hospice referral to death was significantly short in group 1 with 15.5 days compared to group 2 with 53 days. Statistically more prevalent symptoms in group I were ascites, dyspnea, peripheral edema, and hepatic encephalopathy with abnormal laboratory findings (jaundice, hypoalbuminemia, or renal insufficiency). There, however, was no significant difference in complications and managements during admission between group 1 and 2. Conclusion: Most terminal HCC patients were often accompanied with chronic liver disease. The length of hospice and palliative care for above patients was not enough to attend them. Therefore, we suggest that proper education and information should be provided to physicians, patients, and their family members for effective hospice and palliative care.

• Journal of Hospice and Palliative Care
• /
• v.16 no.2
• /
• pp.108-117
• /
• 2013

Purpose: The objectives of this study were to 1) explore nurses' attitudes toward death, coping with death, understanding and performance regarding end-of-life (EOL) care, 2) describe correlations among the above factors, and 3) determine the factors affecting nurses' EOL care performance. Methods: Study participants were 187 nurses stationed at departments that post higher mortality than others such as the oncology department, intensive care unit (ICU) and emergency department (ED). Data were collected from three urban university-affiliated hospitals. Multi-dimensional measure was performed for study instruments such as "attitude toward death", "coping with death" and "understanding and performance regarding EOL care". Data were analyzed by using descriptive statistics, correlation, and multiple regressions. Results: First, nurses showed significantly different attitudes toward death by age, religion, work unit and EOL care education. Younger nurses tend to score low on the understanding of EOL care, and ED nurses' score was lower than their peers at the oncology department and ICU. Second, EOL care performance was positively correlated with attitude toward death (P<0.001), coping with death (P=0.003) and understanding of EOL care (P<0.001). Third, nurses' EOL care performance was affected by work unit (P<0.001) and understanding of EOL care (P<0.001). Conclusion: Because nurses' performance was influenced by their work unit and understanding of EOL care, they should be provided with appropriate training to improve their understanding of death and EOL care according to work unit.

• Journal of Hospice and Palliative Care
• /
• v.19 no.4
• /
• pp.292-295
• /
• 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 Hospice and Palliative Care
• /
• v.5 no.1
• /
• pp.31-42
• /
• 2002

Purpose : The purpose of this study was to evaluate the present status of hospice palliative care programs in Korea as a basic database for standardization of hospice palliative care. Method : The data was collected from July to October, 2001. The instrument used for this study was the questionnaires which was consisted of the general characteristics of organization, recipient of service, manpower, contents of service, financial conditions and facilities. Sixty-four hospice palliative care programs answered the questionnaires, confirmed by telephone. Results : They were 40 hospital-based hospice palliative care programs and 24 nonmedical hospice palliative care programs. 11 Hospital-based hospice palliative programs have isolated unit or hospital affiliated free standing hospice. 6 Non-hospital hospice palliative programs have a free standing hospice. Major subjects of hospice palliative program were terminal cancer patients but patients with non-terminal illness were also included. Only 24 of 64 hospice palliative programs had all of the essential professionals : physicians, nurses, social workers, and clergies. Home hospice palliative care programs have a referral system in hospital based (89.7%) and nonmedical programs (73.7%). 24hr hospice are were provided in 26 hospital-based (65.0%) and 9nonmedical programs (37.5%). There were rooms for family in half of hospital-based programs. 73.9% of hospice palliative care programs have financial problems. 62.0% of Hospice palliative care programs need financial support from government. Conclusion : 64 Hospice palliative care programs provided hospice palliative services but had many problems in manpower, quality of care and facility. For improving the quality of terminal patients' life and promoting the cost effectiveness of health care resources, it is necessary to consider the standardization and institutionalization of hospice palliative care.