• 성인간호학회지
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• 제18권5호
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• pp.746-759
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• 2006

Purpose: This study was designed to systematically explore and elicit information about terminally ill cancer patients' and primary family caregivers' subjectivity of death. Method: Using Q-methodology, 21 terminally ill cancer patients and 19 primary family caregivers sorted 40 statements during personal interviews. Results: The results of this study show that terminally ill cancer patients have four factors ('Attachment to life', 'Hope for heaven', 'Resignation to reality', 'Avoidance of pain') of response and primary caregivers have four factors('Dependence on religion', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality'). Comparing the subjectivities of death of terminally ill cancer patients and primary family caregivers, 'Hope for heaven' and 'Dependence on religion' reveal the similarities of their outlook. On the other hand, 'Attachment to life', 'Resignation to reality', 'Avoidance of pain', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality' reveals different aspects of their outlook. The group of terminally ill cancer patients and their families divided into four types. Type A was 'Attachment to life and Agony of reality', type B was 'Attachment to life and Obedience to fate', type C was 'Hope for heaven and Dependence on religion' and type D was 'Resignation to reality and Faithfulness to reality'. The positive group was C or 'Hope for heaven and Dependence on religion'. Conclusion: There are significant differences found in the subjective structure of death among terminally ill cancer patients and primary family caregivers. Therefore, it is necessary to develop an individualized nursing intervention for terminally ill cancer patients and family caregivers.

• 대한간호학회지
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• 제53권3호
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• pp.340-358
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• 2023

Purpose: This study aimed to develop an instrument to showcase Dignity in Care of Terminally Ill Patients for Nurses and to examine its validity and reliability. Methods: A total of 58 preliminary items on dignity in care of terminally ill patients for nurses were selected using content validity analysis and expert opinions on 97 candidate items derived through a literature review and qualitative focus group interviews. Questionnaires were administered to 502 nurses caring for terminally ill cancer patients at hospice and palliative care institutions. The data were analyzed using item analysis, exploratory and confirmatory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity, reliability was tested using Cronbach's alpha. Results: The final instrument consisted of 25 items, with four factors identified through confirmatory factor analysis. Four factors-ethical values and moral attitudes, interaction-based communication, maintaining comfort, professional insight and competence-accounted for 61.8% of the total variance. Cronbach's α for total items was .96, and test-retest reliability of intraclass correlation coefficient was .90. Conclusion: Since its validity and reliability have been verified through various methods, the Dignity in Care Scale of Terminally Ill Patients for Nurses can be used for develop nursing interventions and improve dignity in care of terminally ill patients.

• 대한간호학회지
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• 제21권3호
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• pp.418-435
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• 1991

The purposes of this study were to find out the effects of hospice care for the quality of life of the terminally - ill patients and to analyze the relationship between the effect of hospice care and the general characteristics of subjects. The subjects of the study were 32 terminally - ill patients hospitalized in the two general hospitals in Seoul, which have the hospice care unit. The data were collected using the questionnaire with interviews. They were done from Sept.28, 1989 to March 20, 1991. The tools used for the research were 17-item questionnaire regarding general characteristics, 42-item questionnaire about the quality of life (11- item for physical, 16 for psychosocial, and 15 for spiritual). The questionnaires were to measure the duality of life by means of the measure instruments of Betty R. Farewell(1989), Stein Kaasa(1988), Palm Pamela(1987), and Hwa-sook Choi(1987). 42 items were used after pre-test. In accordance with each purpose in this study, frequency and percentage were used on the general characteristics of subjects. ANOVA, t-test, and Pearson correlation were employed to evaluate the general characteristics of subjects and different level of quality of life before-and-after hospice care. The results of the study may be summarized as follws : 1. The effects of hospice care. Main Hypothesis : “The quality of life of the terminally - ill patients will be different from before-and-after hospice care” was supported(t＝6.82, df＝31, p＝ .000). Sub Hypothesis 1 : “The quality of life of the terminally - ill patients in the physical aspects will be different from before - and -after hospice care” was not supported(t＝0.07, df＝31, p＝ .946). Sub Hypothesis 2 : “The quality of life of the terminally - ill patients in the psychosocial aspects will be different from before-and-after hospice care” was supported (t＝4.69, df＝31, p＝ .000). Sub Hypothesis 3 : “The quality of life of the terminally - ill patients in the spiritual aspects will be different from before-and-after hospice care” was supported(t＝6.64, df＝31, p＝ .000). 2. Relationship between the general characteristics of subjects and the effects of hospice care. (1) The more the number of family, the higher the quality of life in the psychosocial aspects. (2) The higher the age of the patient, the lower the quality of life in the psychosocial aspects. (3) The high educational level of patients enjoy the high quality of life in general. (4) The high religious level of petients enjoy the higy Quality of life in the spiritual aspects. As a results of analysis above : 1. The most effective aspects of the hospice care to the terminally- ill patients was spiritual aspects. The next effective aspects was psychosocial area. 2. The least effective aspcets of the hospice care to the terminally- ill patients was physical aspects. Further study is needed to improve the quality of life in the physical aspects.

• 대한한의학회지
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• 제25권4호
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• pp.152-160
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• 2004

Objective : Recently, an increasing portion of cancer patients use various therapies of complementary and alternative medicine (CAM) including traditional oriental medicine, which is believed to improve the consequence of cancer according to clinical experience and laboratory data. But the clinical-based systemic statistic validity of these therapies is lacking, so this study was aimed to validate the traditional oriental therapies (TOT) for terminally ill cancer patients. Patients and methods : This retrospective study was performed on 273 patients who were diagnosed with terminally ill cancer in Korea and treated with TOT in the oriental hospital of Daejeon University, from March 1997 to June 2003. We examined the median duration of the terminal period and the correlations between 9 factors and survival of terminally ill cancer patients. Results : During the study period, we could confirm 142 patients' death (52.01%) in 273 subjects. The median length of survival in terminally ill cancer patients was 16 weeks (95%CI 14.0∼20.0) and 40.15% (95%CI 40.07∼40.22) of patients had survived more than 24 weeks. According to Cox's proportional hazard model including gender, age, conventional therapies (chemotherapy, radiotherapy and surgery), performance status and clinical symptoms as independent variables, history of conventional therapies (RR 0.581, 95%CI 0.381∼0.885), higher performance status (RR 1,855, 95%CI 1.454∼2.366) and absence of ascites and pleural effusion (RR 1.631, 95%CI 1.047∼2.538) showed independent prognostic value of survival. Conclusion : Our findings suggest that TOT offer potential benefits for cancer patients at the terminal stage.

• Journal of Hospice and Palliative Care
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• 제15권2호
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• pp.99-107
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• 2012

목적: 말기암환자의 여명 예측은 치료의 이득과 위해를 판단하는 잣대가 되고, 적절한 의료 중재 제공 및 환자의 자율성에 기초한 의사결정에 중요한 기준이 된다. 특히 많은 수의 말기암환자는 암성 식욕부진-악액질 증후군으로 사망에 이르기 때문에 본 연구에서는 이를 반영할 수 있는 혈장 렙틴 농도와 생존기간과의 연관성을 알아보고자 하였다. 방법: 2009년 7월부터 2010년 7월까지 13개월 동안, 만 20세 이상의 말기암환자 69명을 대상으로 혈장 렙틴 농도를 측정하고, 생존기간을 조사하였다. 나이, 성별, 원발암 부위, 암 치료 경력, 전이여부, 투약상황 및 활력증후, 백혈구 수, 혈색소, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), C-반응성 단백질, 총 빌리루빈, 총 콜레스테롤, 알부민, 렙틴 등의 혈액검사를 시행하였다. 결과: 혈장 렙틴 농도와 성별, 나이, 백혈구 수, 혈색소, AST, ALT, 총 빌리루빈, C-반응성 단백질, 통증강도 등의 상관 관계 분석 결과 렙틴과 생존기간에는 통계적으로 유의한 양의 상관 관계를 보였으며, 단변량 분석한 결과 혈장 렙틴 농도는 생존기간과 통계적으로 경계수준의 유의한 관계를 보였으나, 단변량 분석에서 생존 기간에 유의한 영향을 미치는 성별, 백혈구 수, AST, ALT, 총 빌리루빈, 알부민, C-반응성 단백질을 포함하여 시행한 다변량 분석에서 혈장 렙틴 농도는 생존기간과 통계적으로 유의한 관계가 없는 것으로 나타났다. 결론: 암성 식욕부진-악액질 증후군과 관련이 있는 혈장 렙틴 농도와 말기암환자의 생존기간과는 통계적으로 유의한 연관성을 보이지는 않았다. 그러나, 소화기계암환자에 있어서는 혈장 렙틴 농도가 생존기간 예측인자로서 쓰일 수 있는 가능성을 보여주었다.

• Journal of Hospice and Palliative Care
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• 제15권3호
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• pp.147-154
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• 2012

목적: 본 연구의 목적은 의식 없는 말기환자 가족의 연명치료 중단 결정 경험을 이해하기 위함이다. 방법: 자료는 의 없는 말기환자의 연명치료 중단 결정을 한 8명의 가족으로부터 심층면담을 통해 수집하였다. Colaizzi의 현상학적 분석 방법이 자료 분석을 위해 사용되었다. 결과: 주제는 12개의 주제모음으로 분류되었고, 12개의 주제모음은 마침내 5개의 범주로 통합되었다. 5개의 범주는 환자상태로 인한 절망감, 의료진의 권고에 마음을 비움, 환자의 바램, 돌봄으로 인한 가족의 소진, 연명치료와 관련된 과거의 경험이었다. 결론: 다섯 개의 범주를 통하여 의식 없는 말기환자 가족의 연명치료 중단 결정 과정에서 발생할 수 있는 현상들을 이해함으로써 적절한 상담과 간호를 제공하여 보다 바람직한 호스피스 완화의료 중재가 필요하다고 본다.

• Healthcare Informatics Research
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• 제24권4호
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• pp.317-326
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• 2018

Objectives: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.

• 지역사회간호학회지
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• 제12권1호
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• pp.175-186
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• 2001

To evaluate the effect of informational support by hospice team on family caregivers of terminally ill cancer patients. 22 family caregivers of D University Hospital in Daegu city were participated. The research was conducted from Aug. 16th to Oct. 28th 2000 by using self-reported questionnaires. The instruments used in this study were the Weinert's scale of perceived social support. Spielberger's state anxiety inventory. CES-D. and Ellison and Paloutzian's spiritual well-being scale. The intervention was designed to give educational and counselling program up to 7 times within 4 weeks. Educational and counselling booklets which made by the researcher were used step by step by hospice team, he data were analysed frequency. percentage. Wilcoxon Singed Ranks Test with SPSS Win l0.0/PC. The results obtained from this study were as follows; 1. The perceived social support of family caregivers was significantly increased after ready planned informational support was applied by hospice team(z=-3.045. p=0.002). 2. The anxiety of family caregivers was significantly reduced after ready planned informational support was applied by hospice team(z =-3:348. p=0.001). 3. The depression of family caregivers was significantly reduced after ready planned informational support was applied by hospice team(z=-3.641. p=0.000). 4. The spiritual well-being score of family caregivers was not significantly improved after ready planned informational support was applied by hospice team(z=-0.422. p=0.673). In conclusion. the results of this study clearly suggests that the informational support provided by hospice team not only increased the family caregivers' who are caring for terminally ill cancer patients. Therefor the informational support program designed by researcher for family caregivers who are caring for terminally ill cancer patients should be utilized and expended.

• 한국호스피스완화의료학회:학술대회논문집
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• 한국호스피스완화의료학회 2000년도 동계학술대회
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• pp.162-174
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• 2000

The purpose of this hermeneutic study was to investigate the meaning of "good dying" of Chinese terminally ill cancer patients in Taiwan; the factors related to this morning; and the strategies cancer patients used to ensure "good dying". Indepth unstructured interviews, prolonged participant observations, and review of clinical records were selected as the methods for data collection. In the four and one-half month period of data collection, the researcher was in the role of a full time clinical nurse specialist who directly took care of the subject patients in 4 hospitals and in patients' homes. The 20 subject were selected purposively according to selection criteria and various demographic backgrounds. Interview transcripts and field notes comprised the data for analysis. The results were composed by 3 constitutive patterns and 12 themes. Achieving inner peace appeared to herald the good dying state. The "good dying" for Chinese terminally ill cancer patients in Taiwan meant peace of body, peace of mind, and peace of thought. The constitutive pattern of peace of body included 4 themes: (1)minimizing the agony of physical symptoms; (2)short period of dying process without lingering death; (3) cleanliness, neatness, and integrity of the body; and (4) mobility. The constitutive pattern of peace of mind included 5 themes: (1) yielding; (2) non-attachment; (3) not to be lonely; (4) settle down all affairs; and (5) being in a preferred environment and enjoying nature. The third constitutive pattern of peace of thought included 3 themes: (1) getting through day by day without thinking; (2) meaningful life; and (3) expectation that the suffering would be ending. Through understanding of the terminally ill cancer patient' needs in their meanings of "good dying", recommendations can be made for humanistic care. The findings of this study have recommendations for care givers daily contact with dying patients and for medical and nursing education.

• 종양간호연구
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• 제10권1호
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• pp.112-118
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• 2010

Purpose: The purpose of this study was to examine the effects of music therapy on pain, depression, and anxiety in terminally ill patients. Methods: Twenty patients in the experimental group were provided with music via headphones for 30-40 min at a time as they requested for 2 weeks, whereas no music was provided for the nineteen patients in the control group. Data were collected using a questionnaire. The research instruments included Visual Analog Scale (VAS) and Depression & Anxiety Inventory Scale. Data were analyzed using ${\chi}^2$-test, t-test, and Fisher's exact test, using SPSS 15.0. Results: There were significant decreases in the scores of pain at present (t=-2.54, p<.05), depression (t=-2.187, p<.05) and anxiety (Z=-2.114, p<.05) in the experimental group compared to those in the control group. Conclusion: Music therapy is considered non-invasive and inexpensive intervention and can be easily applied to alleviate pain, depression and anxiety for terminally ill patients.