• 제목/요약/키워드: Terminally ill

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한국 호스피스 완화의료: 과거, 현재 그리고 미래 (Hospice Palliative Care in South Korea: Past, Present, and Future)

  • 김현숙;홍영선
    • Journal of Hospice and Palliative Care
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    • 제19권2호
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    • pp.99-108
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    • 2016
  • Hospice palliative care (HPC) in Korea has developed steadily since its introduction in 1965. Currently, HPC in Korea is targeted only towards terminal cancer patients and their families, and the national health insurance scheme covers only inpatient hospice care for said patients. In recent years, healthcare professionals and policy makers began to recognize the need for HPC services in diverse settings including outside hospital boundaries, and for all terminally-ill patients. A law on HPC passed in January 2016 allows terminally-ill patients to refuse life-sustaining treatments, and will likely facilitate further development of HPC services. It is critical for the government and all interested parties in the medical, academic and social sectors to collaborate to ensure its success once it takes effect in 2017. This article will briefly review the half-century history of HPC in Korea, and discuss how to prepare for and cope with death and, thereby, improve the quality of death.

Finding Meaning in Life Threatening Illness

  • Kim, Mira
    • Journal of Hospice and Palliative Care
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    • 제23권2호
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    • pp.39-43
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    • 2020
  • This paper aims to explore how to help terminally ill patients and their families find meaning in their suffering from the logotherapeutic perspective, which is the essence of palliative care. For this purpose, this paper examines the main concepts and principles of logotherapy, and specific approaches based on the logotherapeutic perspective to help terminally ill patients and their families find meaning in life are presented. Emphasizing the will to meaning as the primary motive to explain human behaviors and based on its unique perspective of the human being, which is called the dimensional ontology, logotherapy considers the human being to consist of the body, the mind, and the spirit. The dimensional ontology implies that the human being "has" the body and the mind, but the human being "is" the spirit itself. Therefore, even though a human being can be sick physically or psychologically, Accordingly, it is essential to help these patients realize that they are not their illnesses, but just have them, and to rise above themselves to reach out toward something meaningful or someone to love; despite their suffering, they can still do something meaningful, even in a small way. Above all, the most important thing for these patients is to acknowledge that they have already lived a meaningful life and to believe that their meaningful work has been safely preserved in the past and nothing can take it from them, for as spiritual beings, their lives have been meaningful unconditionally.

한국형 호스피스 케어 개발을 위한 기초 조사 연구 (The National Hospice Care Service Development in Korea)

  • 이소우;이은옥;안효섭;허대석;김달숙;김현숙;이혜자
    • 대한간호
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    • 제36권3호
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    • pp.49-69
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    • 1997
  • The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.

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간호사의 가정간호를 위한 교육요구 분석 (A study on educational need of nurses for home care)

  • 문정순
    • 한국보건간호학회지
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    • 제5권2호
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    • pp.5-25
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    • 1991
  • This study was conducted from July to December 1990, in order to diagnose nurses' educational need for home care. The study subjects consisted of 145 nursing educators, and the 3 groups of nurses, namely 250 senior nursing students of diploma and collegiate program, 235 health center nurses, 521 university' hospital nurses in Seoul. Four types of questionaires were formulated by Delphi method. Two questionaires for the nursing educators were designed to measure their expectations of nurses' knowledge and of their skill for home care, and another two questionaires for the nurses to measure their actual home care knowledge and skill. The results of the study were as follows : 1) The mean scores of educators' expectation for home care knowledge were 17.68 for the care of dependence on medical equipment, 17.44 for the care of mobility impairment patient, 16.56 for the care of cardiopulmonary impairment patient, 16.40 for the care of nutrition and elimination impairment patient, '1.20 for the care of psychiatric disorder patient and 9.03 for the care of cancer and terminally ill patient,. 2) The mean scores of nurses' home care knowledge tested by 20 items were 14.36 for the care of mobility impairment patient, 13.28 for the c8;re of dependence on medical equipment, 13.78 for the care of cardiopulmonary impairment patient, 12.92 for the care of nutrition and elimination impairment patient, and those of tested by 10 items were 7.08 for the care of psychologic disorder patient, 7.80 for the care of cancer and terminally ill patient. The sum of means marked 69.23. As for the nurses' home care knowledge categorized by tasks in terms of the group, significant difference were shown in the care of mobility impairment(P=0.00), cancer and terminally ill(P=0.03), nutrition and elimination impairment(P=0.00) and psychologic disorder patient(P=0.00). No significant difference were shown in the care of dependence on medical equipment and cardiopulmonary impairment patient. 3) Regard to educational need of nurses' home care knowledge categorized by task according to the group it was found that all sampled nurses had educational need in the care of mobility impairment, dependence on medical equipment, cardiopulmonary impairment, cancer and terminally ill patient. It was found that health center nurses had educational need in the care of psychologic disorder. No educational need were found in the health center nurses whose career less than 2 years, in the care of mobility impairment, cardiopulmonary impairment and psychologic disorder patient, and in those of career with 2-5 year in the care of psychologic disorder patient. No educational need were found in the hospital nurses whose career more than 15 years, in the care of cardiopulmonary impairment patient and in those of career with 11-15 year, in the care of cancer and terminally ill patient. 4) The mean scores of educators' expectation for home care skill measured by Likert 5 points scale were 4. 21 for assessing, 4.49 for planning, 4.29 for basic care, 4.42 for curative care, 4.40 for rehabilitative care, 4.36 for emergency care, 4.53 for medication, 4.31 for nutritional care, 4.32 for other means for care, and 4.38 for evaluation. 5) Regard to nurses' home care skill measured by Likert 5 points scale of self evaluation, there was a significant difference between the nurses' home care skill and group(P=0.00l). The higher scores reported by students were vital sign checking and basic care while the scores of below medium were curative care and emergency care. The higher scores reported by health center nurses were vital sign checking, other means for care and care of specimen while the scores below medium were curative, emergency and nutritional care. The higher scores reported by hospital nurses were vital sign checking, care of specimen and basic care, while the score below medium was emergency care. 6) Regard to educational need of nurses' home care skill by nursing process activity according to the group it was found that health center nurses had educational need in all nursing skills including vital sign checking, care of specimen, health assessment, socioeconomic assessment, nursing diagnosis, care plan, basic care, curative care, rehabiitative care, psychological care, emergency care, medication, nutritional care, other means for care and evaluation. And students had educational need in all nursing skills except vital sign checking, and hospital nurses had educational need in all nursing skills except vital sign checking, care of specimen and basic care. 7) In short, the result of this study suggests that the curriculum should be organized in accordence with nurses' educational background and their career for the education of nurses for home care. It should be considered to develop the short term educational program focused on curative and rehabilitative care for health center nurse or community health nurse practitioner and which was focused on family care for hospital nurse. Concerning about this field practice for home care nurse, they are required not only community practice but also . clinical practice including emergency, curative and rehabilitative care.

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호스피스 병동에 입원한 말기 암환자의 통증 예측요인 (Factors for the Prediction of Pain in Terminally Ill Cancer Patients in Hospice Units)

  • 용진선;한성숙;노유자;홍현자
    • Journal of Hospice and Palliative Care
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    • 제5권2호
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    • pp.125-135
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    • 2002
  • 목적 : 본 연구는 호스피스 병동에 입원한 말기 암 환자의 통증과 통증에 영향을 미치는 요인인 우울, 불편감, 신체적 간호 시행 횟수, 진통제 사용, 및 영적상태를 평가하기 위한 서술적 조사 연구이다. 대상 : C 대학 3개 부속병원의 호스피스 병동에 새로 입원한 말기 암환자 58명을 대상으로 하였다. 자료수집은 1998년 1월부터 1999년 1월까지 1년간 연구원들의 직접 면접으로 실시하였다. 수집된 자료는 ANOVA, Pearson correlation oefficient, 및 Multivatiate mulitiple regression으로 통계 처리하였다. 결과 : 1) 인구학적 특성:대상자의 나이는 평균 57세 이었고, 60세 이상이 28명(48.3%)으로 가장 많았다. 교육정도는 고등학교 이상 졸업자가 약 53%를 차지하였고, 종교는 가톨릭이 62.1%로 가장 많았다. 결혼 상태는 대부분이 기혼(89.7%)이었고, 가족 수는 2명인 경우가 25.9%, 4명이 19.0%, 없는 경우가 17.2%, 3명이 15.5 % 순이다. 임상적 특성으로 진단명은 위암이 24.1%, 폐암이 17.2%, 직장암이 13.8% 순 이었다. 호스피스 병동에 입원하게된 동기는 통증완화가 67.2%, 영적 간호가 39.7%, 증상완화가 27.6%였다. 수술을 받은 경우는 44.8%, 받지 않은 경우가 55.2%였다. 가족력에 암이 있었던 경우는 27.6%이었고, 일상 수행 정도는 부분적으로 가능한 경우가 65.5%로 가장 많았으며, 전혀 불가능이 22.4%, 그리고 12.1%는 가능하였다. 돌봄과 관련된 특성에서 주 돌봄 제공자가 주로 가족(72.4%)이었으며, 간호 장소는 84.5%가 병원을 선호하였고 그 이유는 통증 조절(51.7%), 언제나 치료가 가능한 점(15.5%), 정서적 안정(15.5%), 그리고 영적 간호(12.1 %) 순으로 나타났다. 대상자 모두는 가정에서의 간호를 염려하고 있었는데 그 이유는 통증 조절이 어렵다는 것(77.6%), 영적 간호 제공자 부재(15.5%), 돌봐줄 사람의 부재(13.8%), 및 가족의 부담감(6.9%)이었다. 통증의 종류를 보면, 대상자의 53.4%가 심부 통증, 20.7%가 복합적인 통증, 17.3%가 내장 통증, 5.2%가 신경성 통증, 3.4%가 표재성 통증을 호소하였다. 마약성 진통제를 사용한 경우는 77.6%였다. 통증 정도는 평균 4.69점이었고, 우울감은 6.13점, 불편감은 4.13점, 그리고 신체간호 시행은 2.59점이였다. 2) 통증과 통증 관련요인과의 상관 관계 :통증과 우울(P<.05), 통증과 신체적 간호(P<.05), 통증과 불편감(P<.05), 우울과 불편감(P<.05)사이에 순 상관 관계를 보여, 우울하고 불편감이 심할 수록 통증이 더 심했으며, 신체 간호 횟수가 많은 경우일수록 통증을 더 느꼈고, 우울할 수록 불편감도 더 심했다. 3) 통증예측 요인 분석: 우울 정도(${\beta}=0.41$, P=0.0049) 와 마약성 진통제 사용 여부(${\beta}=2.11$, P=0.0132)가 환자의 통증 정도($R^2=.46$)에 유의하게 영향을 미쳤다. 결론 : 본 연구의 결과 말기 암환자들 대부분이 입원 당시 중등도 이상의 통증이 있었으며, 통증정도는 우울과 불편감 그리고 신체간호 횟수와 상관관계가 있었고, 우울과 마약성 진통제 사용이 통증 예측인자로 나타났다. 그러므로 말기 암환자의 통증을 완화하기 위해서는 약물요법은 물론 신체적, 심리적, 및 영적 측면과 관련된 총체적인 접근에 의한 다학제간의 중재프로그램이 마련되어야 한다고 본다.

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지역사회 말기질환자 가족 부담감에 관한 연구 (A Study of Family Caregiver's Burden for the Terminally III Patients)

  • 한성숙;노유자;양수;유양숙;김석일;황희경
    • 가정∙방문간호학회지
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    • 제10권1호
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    • pp.58-72
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    • 2003
  • The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18,

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호스피스와 비호스피스 병실에 입원한 말기 암 환자의 진료비용 분석 (Comparisons of Medical Costs between Hospice and Non-hospice Care)

  • 김남초;용진선;유소영
    • Journal of Hospice and Palliative Care
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    • 제10권1호
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    • pp.29-34
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    • 2007
  • 목적: 본 연구는 위암과 폐암 말기로 진단받고 동일 병원에 입원하여 호스피스 대상자와 비대상자로 치료를 받다가 사망한 환자 114명을 대상으로 사망시점부터 14일 전까지의 진료비를 분석하여 양 대상을 비교하는데 있다. 방법: 진료비 분석에 대한 후향적 조사연구 설계로서 진료비 분석에 대한 도구는 C 대학 K 병원의 진료비 계산서 영수증을 기초로 하여 작성된 11개 항목에 대한 각각의 진료비 및 총액이었다. 결과: 호스피스 대상자의 진료비가 비 호스피스 대상자에 비해 낮았는데 특히 고단위 영양제, 마약성 진통제, 간호처치료, 방사선 검사, 혈액검사항목에서 통계적으로 유의하게 낮았다. 또한 호스피스 대상자 중에서는 호스피스 전담의의 유무에 따라 진료비의 총액에는 차이가 없었으나 기타 진통제 항목에서 전담의가 있었던 시기가 전담의가 없었던 시기에 비해 진료비용이 유의하게 높았다. 결론: 본 연구결과 동일기간 내 호스피스 대상자의 진료비용이 비 대상자에 비해 약 53%에 지나지 않음을 알 수 있어 범국가적인 차원의 호스피스 제도화 도입이 시급하다고 본다.

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Employment Status and Work-Related Difficulties among Family Members of Terminally Ill Patients Compared with the General Population

  • Kim, Seon Young;Chang, Yoon-Jung;Do, Young Rok;Kim, Sam Yong;Park, Sang Yoon;Jeong, Hyun Sik;Kang, Jung Hun;Kim, Si-Yung;Ro, Jung Sil;Lee, Jung Lim;Lee, Woo Jin;Park, Sook Ryun;Yun, Young Ho
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권1호
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    • pp.373-379
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    • 2013
  • Background: Although caregiving to patients with terminal illness is known to be a stressful burden to family members, little attention has been focused on work-related problems. We aimed to investigate employment status and work-related difficulties of family caregivers of terminal cancer patients, comparing with the general population. Methods: Using structured questionnaires, we assessed family caregivers of 481 cancer patients determined by physicians to be terminally ill, from 11 university hospitals and the National Cancer Center in Korea. Results: Among 381 family caregivers of terminal cancer patients (response rate, 87.6%), 169 (43.9%) were not working before cancer diagnosis, but currently 233 (63.7%) were not working. Compared with the general population (36.5%), the percentage of not working among the family caregivers was higher (OR=2.39; 95%CI=1.73-3.29). A major reason for not working was to provide assistance to the patients (71.6%). 40.6% of those who continued working and 32.3% of those who not working family members reported extreme fatigue. Caregivers of old age, those who were female, those with a lower household income, and those caring for patients with a low performance status were not working at a more significant rate. Conclusion: Family caregivers of terminal cancer patients suffer job loss and severe work-related difficulties, probably due to caregiving itself and to fatigue. We need to develop supportive programs to overcome the burden of caregivers of the terminally ill.

말기암환자가 보완대체요법을 선택한 이유 (The Reason to Select Complementary and Alternative Therapy for Terminally Ill Cancer Patients)

  • 김경운;박진노;이수한
    • Journal of Hospice and Palliative Care
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    • 제14권1호
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    • pp.34-41
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    • 2011
  • 목적: 말기암환자들이 보완대체요법을 선택하게된 주관적 경험을 파악하여, 대상자 입장에서의 당위성을 이해하고 이용과정에서 발생할 수 있는 현상들을 이해함으로써 좀 더 바람직하고 효율적인 이용을 위한 호스피스 완화의료 중재를 하는데 기여하고자 실시하였다. 방법: 심층면담한 내용을 Colaizzi(1976)의 방법을 이용하여 귀납적이고 서술적인 기술과 분석을 실시하였다. 결과: 말기암환자와 가족들이 보완대체요법을 선택한 4가지 범주는 첫째 현대의학의 한계 인식, 둘째 보완대체요법의 효과에 대한 신뢰, 셋째 가족의 정서적 욕구 충족 넷째, 의사의 부정적인 태도로 인한 불신이었다. 주제모음은 9가지로 '불가능한 완치에 대한 기대', '병원치료에 대한 불확실성', '항암치료의 부작용을 해결하기 위한 보조적 수단', '증상완화와 생명연장을 위함', '암치료의 부작용에 대한 두려움', '체험과 정보에 대한 신뢰', '타인의 권유', '가족으로서 도리를 다함', '의사의 부정적 태도에 불만족'이었다. 결론: 암환자의 치료 결정과정에서 대상자와 의사가 바람직한 의사소통과정을 통하여 현대의학 치료에 대한 설명이 충분히 이루어져서 대상자가 일반적인 호스피스 완화의료 서비스를 이용하고 과학적인 근거에 바탕을 둔 보완대체요법에 대한 정확한 정보 제공이 필요하다고 본다.

임종 전 말기 암 환자의 임상 증상 및 징후의 변화 (Clinical Change of Terminally Ill Cancer Patients at the End-of-life Time)

  • 고수진;이경식;홍영선;유양숙;박혜자
    • Journal of Hospice and Palliative Care
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    • 제11권2호
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    • pp.99-105
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    • 2008
  • 목적: 본 연구에서는 호스피스 병동에 입원한 말기 암 환자들을 대상으로 임상적으로 보다 정확한 잔여 수명을 예측하고자 임종의 시기에 객관적으로 임상적 증상 및 징후들의 변화를 관찰하였다. 방법: 강남성모병원 호스피스센터를 방분한 말기 암 환자를 대상으로 입원 시부터 임종까지 말기에 흔히 나타나는 증상과 신체적 징후의 변화를 관찰하였다. 증상의 정도는 $0{\sim}3$점수화하였으며 신체적 징후는 있다 또는 없다로 구분하였다. 이밖에 활력증후와 통증 정도, 진통제 사용을 관찰하였다. 결과: 호흡곤란, 혼수의 증상은 입원 시와 비교해서 임종 $1{\sim}2$일 전에 악화되었다. 대상자의 활동 수행 능력은 임종 시간이 가까워질수록 점진적으로 감소하였고, 섭취량과 소변 배설량도 줄어들었다. 특히 임종 $1{\sim}2$2일 전부터 현저하게 혈압이 감소하였다. 임종 시점을 기준으로 시기에 따라 증상의 변화가 유의하게 나타난 임상 지표는 활동수행 능력, 수축기 혈압, 구강건조증, 식욕저하, 쇠약감, 변비, 황달, 부종, 욕창, 호흡곤란, 진정, 혼수, 청색증, 호흡이상, 가래 끓는 소리, 눈을 뒤로 젖힘 등이었다. 결론: 말기 암 환자에서 수축기 혈압의 감소, 호흡곤란, 진정, 혼수, 청색증, 호흡이상, 가래 끓는 소리, 눈을 뒤로 젖힘 등의 증상이 나타나면 임종이 임박했음을 예상하여 가족들과 환자가 준비할 수 있도록 해야 하며, 의료진도 임종에 관한 돌봄을 시행하도록 해야 한다.

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