• Journal of Hospice and Palliative Care
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• v.23 no.3
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• pp.162-165
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• 2020

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill and has exposed the lack of preparedness of most nations' health care systems. Even in usual times, palliative care has not received its fair share of recognition as an important component of patient care; instead, the emphasis is often placed on aggressive patient management. Now, with the entire medical community and decision-making committees focussed on intensive patient care, end-of-life care has taken a backseat. Methods: This article is a brief communication. Results: COVID 19 infection has been shown to lead to greater mortality and morbidity in patients with pre-existing illnesses such as hypertension, diabetes, renal failure, and cancer. Patients typically in need of end-of-life care, such as those with late-stage cancer or heart failure, are therefore at a higher risk of both contracting COVID-19 and suffering a more severe disease course. The strict nationwide lockdowns being imposed in most countries have deterred patients from seeking medical attention or hospice care. Every day new research is coming to light regarding COVID 19. This has helped significantly in creating awareness and limiting the spread of disease. However, misinformation is also rampant, leading to discrimination and mistreatment of infected patients. Conclusion: This pandemic has been a terrifying ordeal for all and has exposed our entire population physically, psychologically, emotionally, and financially to unimaginable stresses. In the present scenario, EOL care is as much a necessity as intensive care and should be given at least a fraction of its importance.

• Journal of Hospice and Palliative Care
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• v.6 no.1
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• pp.34-44
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• 2003

Purpose : The purpose of this study was to elucidate the effects of hospice care on pain management of the terminal cancer patients. Method : The subjects of the study were 37 terminal cancer patients hospitalized in the general hospital in JeonJu with the hospice care nit. The data were collected using the questionaire with interviews from July to Nov. in 2000. The severity and interference of pain were examined with the self reported survey based on the Korean version of Brief Pain Inventory (BPI-K). The data were analyzed with the mean, SDs, paired t-test. The hospice care to provide for three weeks. Results : 1) The mean scores of the worst pain for the last 24-hours measured with the pain severity of BPI-K were pre-intervention (6.35) and post (4.76). The pain interference of BPI-K in pre-intervention was enjoy (8.22), work (7.46), walk (7.08) and activity (7.08), while post was of enjoy (6.62), work (6.43), walk (6.11) and activity (5.78), respectively. 2) In pain severity, significant difference was found between the pre-intervention and post in all of followings. - worst pain for last 24 hours (t=4.085, P=.000) - least pain for last 24 hours (t=4.020, P=.000) - average pain for last 24 hours (t=4.254, P=.000) - pain right now (t=4.017, P=.000) 3) In pain interference, significant difference was found between the pre- intervention and the post in all of followings. - activity (t=3.137, P=.003) - mood (t=6.713, P=.000) - walk (t=2.027, P=.050) - work (t=2.132, P=.040) - relate (t=4.143, P=.000) - sleep (t=4.071, P=.000) - enjoy (t=3.881, P=.000) Conclusion : The terminal cancer patients who were offered hospice care had significantly lower hospice care pain and pain interference than those without hospice care. According to these results, hospice care can be regarded as an effective modality in relief of pain in the terminal ill-patients.

• 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.

• The Korean Nurse
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• v.28 no.3
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• pp.52-67
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• 1989

True nursing care means total nursing care which includes physical, emotional and spiritual care. The modern nursing care has tendency to focus toward physical care and needs attention toward emotional and spiritual care. The total nursing care is mandatory for patients with terminal cancer and for this purpose, hospice care became emerged. Hospice case originated from the place or shelter for the travellers to Jerusalem in medieval stage. However, the meaning of modem hospice care became changed to total nursing care for dying patients. Modern hospice care has been developed in England, and spreaded to U.S.A. and Canada for the patients with terminal cancer. Nowaday, it became a part of nursing care and the concept of hospice care extended to the palliative care of the cancer patients. Recently, it was introduced to Korea and received attention as model of total nursing care. This study was attempted to assess the efficacy of hospice care. The purpose of this study was to prove a difference in terms of physical, emotional a d spiritual aspect between the group who received hospice care and who didn't receive hospice care. The subject for this study were 113 patients with advanced cancer who were hospitalized in the S different hospitals. 67 patients received hospice care in 4 different hospitals, and 46 patients didn't receive hospice care in another 4 different hospitals. The method of this study was the questionaire which was made through the descriptive study. The descriptive study was made by individual contact with 102 patients cf advanced cancer for 9 months period. The measurement tool for questionaire was made by author through the descriptive study, and included the personal religious orientation obtained from chung(originated R. Fleck) and 5 emotional stages before dying from Kubler Ross. The content ol questionaire consisted in 67 items which included 11 for general characteristics, 10 for related condition with cancer, 13 for wishes far physical therapy, 13 for emotional reactions and 20 for personal religious orientation. Data for this study was collected from Aug. 25 to Oct. 6 by author and 4 other nurse's who received education and training by author for the collection of data. The collected data were ana lysed using descriptive statistics, $X^2-test$, t-test and pearson correlation coefficient. Results of the study were as follows: "H.C Group" means the group of patient with cancer who received hospice care. "Non H.C Group" means the group of patient with cancer who did not receive hospice care. 1. There is a difference between H.C Group and Non H.C Group in term of the number of physical symptoms, subjective degree of pain sensation and pain control, subjective beliefs in physical cure, emotional reaction, help of present emotional and spiritual care from other personal, needs of emotional and spiritual care in future, selection of treatment method by patients and personal religious orientation. 2. The comparison of H.C Group and Non H.C Group 1) There is no difference in wishes for physical therapy between two groups(p=.522). Among Non H.C Group, a group, who didn't receive traditional therapy and herb medicine was higher than a group who received these in degree of belief that the traditional therapy and herb medicine can cure their disease, and this result was higher in comparison to H.C Group(p=.025, p=.050). 2) Non H.C Group was higher than H.C Group in degree of emotional reaction(p=.050). H.C Group was higher than Non H.C Group in denial and acceptant stage among 5 different emotional stages before dying described by Kubler Ross, especially among the patient who had disease more than 13 months(p=.0069, p=.0198). 3) Non H.C Group was higher than H. C Group in demanding more emotional and spiritual care to doctor, nurse, family and pastor(p=. 010). 4) Non H.C Group was higher than H.C Group in demanding more emotional and spiritual care to each individual of doctor, nurse and family (p=.0110, p=.0029, P=. 0053). 5) H.C Group was higher th2.n Non H.C Group in degree of intrinsic behavior orientation and intrinsic belief orientation of personal religious orientation(p=.034, p=.026). 6) In H.C Group and Non H.C Group, the degree of emotional demanding of christians was significantly higher than non christians to doctor, nurse, family and pastor(p=. 000, p=.035). 7) In H.C Group there were significant positive correlations as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and: the degree of intrinsic behavior orientation in personal religious orientation(r=. 5512, p=.000). (2) Between the degree of emotional demandings to doctor, nurse. family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.4795, p=.000). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic: belief orientation in personal religious orientation(r=.8986, p=.000). (4) Between the degree of extrinsic religious orientation and the degree of consensus religious orientation in personal religious orientation (r=. 2640, p=.015). In H.C. Group there were significant negative correlations as following; (1) Between the degree of intrinsic behavior orientation and extrinsic religious orientation in personal religious orientation (r=-.4218, p=.000). (2) Between the degree or intrinsic behavior orientation and consensus religious orientation in personal religious orientation(r=-. 4597, p=.000). (3) Between the degree of intrinsic belief orientations and the degree of extrinsic religious orientation in personal religious orientation(r=-.4388, p=.000). (4) Between the degree of intrinsic belief orientation and the degree of consensus religious orientation in personal religious orientation(r=-. 5424, p=.000). 8) In Non H.C Group there were significant positive correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic behavior orientation in personal religious orientation(r= .3566, p=.007). (2) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.3430, p=.010). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic belief orientation in personal religious orientation(r=.9723, p=.000). In Non H.C Group there were significant negative correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of extrinsic religious orientation in personal religious orientation(r= -.2862, p=.027). (2) Between the degree of intrinsic behavior orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5083, p=.000). (3) Between the degree of intrinsic belief orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5013, p=.000). In conclusion above datas suggest that hospice care provide effective total nursing care for the patients with terminal cancer, and hospice care is mandatory in all medical institutions.

• The Korean Journal of Pain
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• v.27 no.2
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• pp.139-144
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• 2014

Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from $7{\pm}1.0$ at baseline to $3.6{\pm}1.4$ on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.

• Journal of Hospice and Palliative Care
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• v.5 no.1
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• pp.24-30
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• 2002

Background : Pain is one of the most feared consequences of cancer. $65{\sim}85%$ of cancer patients experienced severe pain, and sometimes high dose morphine is used to these patients. But many doctors still have 'opioid-phobia' and hesitate to use high dose morphine. We investigated the morphine therapy in terminal cancer patients during the last 1 week to death, and found any differences according to the morphine dosage. Methods : 93 patients admitted to National Health Insurance Corporation Ilsan Hospital, department of family medicine for hospice care between September 2000 and the end of October 2001 and lived more than 1 week entered in the study. We investigated the demographic data, laboratory tests and sufficient dosage of morphine for pain control. According to the calculated dosage by OME(oral morphine equivalent), patients were divided into low dosage group (${\leq}150mg/day$) and high dosage group (>150 mg/day). The chi-squared test were used to evaluate the influence of age, gender, tumor sites, metastasis and adverse effects of morphine. Results : Mean age was $65.0{\pm}13.1year$ in low dosage group and $59.9{\pm}11.6year$ in high dosage group. 32 men (50.0%) and 32 women (50.0%) were included in low dosage group and 15 men (51.7%) and 14 women (48.3%) in high dosage group. Stomach was the most frequent tumor site and lung was the next. Metastasis were found 58 (90.6%) in low dosage group and 28 (96.6%) in high dosage group. In other palliative radiotherapy and adverse effects, there were no differences in both group. Conclusion : During the last 1 week to death in cancer patients, there were no difference according to the morphine dosage. So we don't have to have 'opioid-phobia' in treating the terminal cancer patients.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.57-65
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• 2014

Purpose: Since most terminally ill cancer patients die of multiple organ failure, plasma endotoxin concentration levels may be used to predict the life expectancy. This study was performed to evaluate the clinical significance of endotoxin level in plasma as a prognostic factor for survival in patients with terminal cancer. Methods: This study was conducted with 56 terminally ill cancer patients, above 20 years old, from April 2009 through October 2009. Demographic characteristics, Karnofsky performance status, and survival time were evaluated. We analyzed blood levels of white blood cell hemoglobin, hematocrit, aspartate aminotransferase, alanine aminotransferase, c-reactive protein, total bilirubin and endotoxin in each patient. Results: We considered following variable for univariate analysis: plasma endotoxin level, sex, age, WBC, hemoglobin, hematocrit, AST, ALT, total bilirubin, CRP and severity of pain. Univariate analysis did not show a significant association between plasma endotoxin level and survival time. However, in a multivariate analysis with factors that were found to be significantly associated with survival sex, WBC count and total bilirubin level in univariate analysis, high levels of plasma endotoxin and short survival time were significantly related. Conclusion: Plasma endotoxin level could be used as a prognostic factor to predict the life expectancy of terminally ill cancer patients.

• Journal of Korean Academy of Nursing
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• v.39 no.4
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• pp.528-538
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• 2009

Purpose: This study was done to develop and test a palliative care program based on home care nursing. Methods: A quasi-experimental design was employed. Changes in the variables were evaluated to test effects of the developed program. Participants were patients with terminal cancer and their families receiving home care nursing from six hospitals (experimental group: 24 and control group: 22). Data collection was conducted from February to October, 2006. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and repeated measures ANOVA were used to analyse the data. Results: Hypothesis 1, the experimental group receiving this program will experience less pain (severe, average, weak pain) than the control group, was supported. Hypothesis 2, the experimental group will have less symptom experience than the control group, was supported. Hypothesis 3, the experimental group will have higher QOL than the control group, was supported and the last hypothesis 4, family burden in the experimental group will be less than the control group, was supported. Conclusion: The home care nursing based palliative program developed in this study was found to be an effective program to reduce patient pain and symptom experience, to improve patient QOL and to decrease family burden.

• The Korean Journal of Pain
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• v.3 no.1
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• pp.21-26
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• 1990

One hundred among 320 patients who underwent splanchnic nerve block were evaluated retrospectively by telephone or letters. After splanchnic nerve block most of the patient experienced relatively good pain relief until death. The results were as follows 1) The duration of pain relief and survival time were well correlated. 2) The duration of survival time after the block was varied from 35 days to 240 days. These data suggest that the splanchnic nerve block is a satisfactory and reliable method for terminal cancer pain and results in a painless life until death.

• 한국호스피스완화의료학회:학술대회논문집
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• 2008.07a
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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: