• Journal of Hospice and Palliative Care
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• 제15권4호
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• pp.188-192
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• 2012

Palliative medicine has shown demonstrated benefit for patients with serious illness, their families, and hospital systems. As such, the demand for palliative care services is growing at a fast pace, and health care facilities frequently struggle to develop and implement effective and sustainable methods of providing this care. As with any new system, challenges and barriers naturally exist to instituting palliative care. Undertaking careful assessment, planning, and resource allocation can provide the greatest likelihood of success when developing these novel yet much needed models of care. This summary paper offers a qualitative overview of the potential benefits and the rationale to implement robust palliative care systems. We briefly review the history of palliative medicine in the broadest sense and address several seminal works from the US palliative care literature. Core practices to establish and advance palliative medicine are suggested. Commentary is provided on some of the particular barriers to palliative system development that may need to be addressed in the context of Korean medical culture. Collectively, we hope this overview can contribute to a framework within which such research and development can occur, leading to increasingly effective and sustainable palliative medicine in Korea.

• Journal of Hospice and Palliative Care
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• 제24권3호
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• pp.165-173
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• 2021

Purpose: This study aimed to compare the attitudes of nurses and physicians toward neonatal palliative care and identify the barriers to and facilitators of neonatal palliative care, with the goal of improving palliative care for infants in neonatal intensive care units (NICUs). Methods: This cross-sectional study analyzed data from the NICUs of seven general hospitals with 112 nurses and 52 physicians participating. Data were collected using the Neonatal Palliative Care Attitude Scale questionnaire. Results: Only 12.5% of nurses and 11.5% of physicians reported that they had sufficient education in neonatal palliative care. In contrast, 89.3% of the nurses and 84.6% of the physicians reported that they needed further education. The common facilitators for both nurses and physicians were: 1) agreement by all members of the department regarding the provision of palliative care and 2) informing parents about palliative care options. The common barriers for both nurses and physicians were: 1) policies or guidelines supporting palliative care were not available, 2) counseling was not available, 3) technological imperatives, and 4) parental demands for continuing life support. Insufficient resources, staff, and time were also identified as barriers for nurses, whereas these were not identified as barriers for physicians. Conclusion: It is necessary to develop hospital or national guidelines and educational programs on neonatal palliative care, and it is equally necessary to spread social awareness of the importance of neonatal palliative care.

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.252-255
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• 2020

This article aims to discuss the barriers hindering cancer patients from receiving early palliative care, which has been demonstrated to be more effective in improving quality of life and controlling symptoms. Specifically, there are barriers in four aspects of delivering early palliative care. First, the difficulty of starting discussions about early palliative care and the lack of adequate appointment time can impede communication between oncologists and patients and their family members. Second, determining the timing of referral and deciding upon and applying a standard for referral can be barriers in the process of referral from oncology to palliative care. Third, palliative care patients and their family members can face difficulties regarding in what format and by whom the services will be delivered. Fourth, biases, misinformation, and inaccurate beliefs can be barriers in the process of patients and their family members accepting care. In order to facilitate early palliative care, research and policy regarding these barriers are necessary, along with efforts made by medical staff.

• Journal of Hospice and Palliative Care
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• 제25권3호
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• pp.133-137
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• 2022

A 72-year-old woman with metastatic lung cancer to bone and brain and with left external iliac vein thrombosis was under the care of a community palliative care provider. She experienced an acute pain crisis due to acute limb ischemia of the left lower limb. Goals-of-care discussions were held with the patient and her family; she prioritized symptom control and end-of-life care at home. The family and patient were aware of her short prognosis. Her complex pain was managed by the community palliative team, and her family was empowered to give subcutaneous injections. We illustrate a case showing the importance of community health services with palliative care support in providing symptom management and support to patient and family caregivers throughout the course of a life-limiting illness. It also highlights family caregivers' potential psychological distress in delivering subcutaneous injections in terminal care for a patient at home.

• Journal of Hospice and Palliative Care
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• 제19권4호
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• pp.283-291
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• 2016

지난 10년 동안 암 관리법에 의한 국가 정책에 따라 일본에서는 호스피스 및 완화의료가 급속히 발전해왔다. 완화의료 시설 및 입원 환자의 호스피스, 병원의 완화 의료팀, 가정 호스피스 기능을 갖춘 진료소의 수는 꾸준히 증가하고 있으며 국가 협회로부터 완화의료 전문가로 공인된 의사, 간호사, 약사의 수도 증가하고 있다. 학부, 대학원 및 계속적인 의학 교육을 통해서 교육프로그램 및 교육의 기회를 표준화하고 보급하기 위한 공동 노력이 이루어졌다. 일본의 연구 활동은 말기 섬망, 말기 탈수증, 완화적 진정, 임종 환자의 의료, 예후, 의사 소통, 정신 종양학, 지역적인 완화의료 프로그램의 분야에서 현저하게 기여하였다. 이 보고서에서는 일본에서의 주요 완화의료 환경, 특성, 국가 협회, 교육, 완화의료 연구에 초점을 맞추었다.

• Journal of Hospice and Palliative Care
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• 제23권4호
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• pp.167-171
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• 2020

The finite nature of human existence leads many to search for meaning, which comes into sharper relief for those who are imminently facing death. Therefore, universal existential concerns such as the inevitability of death, existential isolation, loss of meaning, freedom, and dignity are inherent psychological issues in palliative care. Consequently, one of the critical challenges facing palliative care is how to address these issues effectively. This paper provides an overview of common themes of existential concerns and psychotherapeutic interventions to address existential distress among patients in palliative care.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.1-6
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• 2023

This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.32-36
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• 2017

In unresectable stage IV colorectal cancer, the role of palliative surgery is not defined clearly. The palliative surgery can be categorized into two surgeries; first, palliative primary tumor resection; second, palliative metastatectomy. Several retrospective studies reported initial palliative systemic chemotherapy in unresectable stage IV colorectal cancer did not increase primary tumor related complications such as obstruction, perforation and hemorrhage, so they insisted that primary tumor resection in asymptomatic stage IV colorectal cancer should be preserved. However, in terms of overall survival and cancer-specific or progression-free survival, several retrospective studies, especially using population-based big data, reported favored survivals in palliative primary tumor resection group. And also several studies reported that palliative metastatectomy such as liver resection without resection of lung metastasis showed better overall survivals. But those results from those studies came from retrospective studies and are likely to be affected by selection bias. Prospective randomized studies are needed to define the benefit of palliative primary tumor resection and metastatectomy in unresectable stage IV colorectal cancer. However, based on the updated evidences, the dogma that palliative primary tumor resection should be preserved in asymptomatic unresectable stage IV colorectal cancer should be questioned.

• 한국보건간호학회지
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• 제26권2호
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• pp.280-288
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• 2012

Purpose: The purpose of this research was to determine the effects of hospice and palliative care education on knowledge of hospice and palliative care and attitude toward death in nursing students. Method: Subjects of this study included 49 nursing students. Using a one-group pretest-posttest quasi-experimental research design, we conducted experiments to determine the effects of a hospice and palliative care education during a period of seven weeks from August through November 2009. The program was composed of seven sessions (total: 28hrs). The SPSS/Win 18.0 program was used for analysis of collected data. Results: A significant change in knowledge of hospice and palliative care and attitude toward death was observed after the intervention. Conclusion: The hospice and palliative care education was effective for nursing students in improving their attitude toward death and in increasing knowledge of hospice and palliative care. Therefore, I recommend generous application of this program to nursing students in order to improve knowledge of hospice and palliative care and attitude toward death.

• Journal of Hospice and Palliative Care
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• 제15권4호
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• pp.183-187
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• 2012

말기암환자에 대한 완화의료의 중요성은 세계적으로 강조되고 있다. 이에 우리나라에서는 암정복10개년계획을 수립하면서 암에 대한 정책을 기획하였고, 추진되었다. 말기암환자 완화의료사업에 대한 법적 근거를 제시하는 암관리법과 제2기 암정복10개년 계획의 내용을 통해 현재 우리나라의 호스피스 완화의료 제도화 현황을 확인해보고자 한다. 호스피스 완화의료의 제도화는 국가암관리사업의 커다란 틀 안에서 발전되어 왔다. 완화의료기관의 확대 및 전문인력 양성과 질적 향상 등에 대해 2013년 완화의료 수가 본 사업이 시작된 이후에도 호스피스 완화의료의 지속적인 발전을 위하여 발전해야 할 것이다.