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.
Adaptation, Psychological ; Attitude to Death ; Education, Nursing ; Emergencies ; Intensive Care Units ; Terminal Care

PURPOSE: This study was conducted to investigate how home-based hospice care is provided in Korea. METHODS: From July 2011 through August 2011, 29 hospice facilities that provide home-based hospice care were surveyed using a questionnaire. Items included in the questionnaire were general characteristics of the organization, staff members, service programs, difficulties. RESULTS: Among the surveyed, hospice care was hospital-based for 11 (37.9%) facilities, hospital-independent center-based care for four (13.8%) and home-based care only for 10 (34.5%). Near half the participants were located in Seoul and Gyeonggi-do. Caregivers included nurses for 62.1% of the participants, volunteers 62.0%, pastors 44.8%, social workers 37.9%, coordinators 31.0% and doctors 31.0%. The facilities offered service programs such as family counseling (96.6%), transfer to other facilities (93.1%), psychological support (89.7%), bereavement support (86.2%), dying care (79.3%), clinical care (75.9%) and spiritual support (75.9%). The major obstacles were financial issues (24.1%), lack of trained staff (20.7%) and staff members' lack of awareness of home-based hospice care (13.8%). CONCLUSION: In Korea, home-based hospice care is provided by an insufficient number of facilities. Moreover, the service providers are experiencing difficulties such as lack of trained staff, insufficient financial resource and staff's lack of awareness of home-based hospice care. It is necessary to increase the number of home-based hospice care facilities with consideration of even distribution across regions and standard staffing and service programs and develop related insurance policies.
Bereavement ; Caregivers ; Counseling ; Health Services ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Insurance ; Korea ; Social Workers ; Surveys and Questionnaires

PURPOSE: Ten years have passed since the Korean government announced its plan to institutionally support hospice and palliative care in 2002. In line with that, this study aims to suggest future directions for Korea's hospice and palliative care policy. METHODS: We conducted a survey on people's perception and acceptance of well-dying. Data were collected from 1,000 participants aged 19~69 years between June 1 and June 11, 2012 via computer-assisted telephone interviews. RESULTS: The most important factor for well-dying was placing no burden of care on others (36.7%) and the second most important factor was staying with their family and loved ones (19.1%). Among nine suggestions of policy support for well-dying, the most popular was the promotion of voluntary care sharing (88.3%), followed by the palliative care training support for healthcare providers (83.7%) and the support for palliative care facilities instead of funeral halls (81.7%). The idea of formulating a five-year national plan for end-of-life care drew strong support (91%). According to the survey, the plan should be implemented by the central government (47.5%), the National Assembly (20.2%) or civic groups (10%). CONCLUSION: This study demonstrated the public consensus and their consistent direction toward policy support for well-dying. Results of this study may serve as a foundation for the establishment of policy support for people's well-dying and palliative care at the national-level.
Aged ; Attitude to Death ; Consensus ; Decision Making ; Health Personnel ; Health Policy ; Hospices ; Humans ; Love ; Palliative Care ; Republic of Korea ; Right to Die ; Telephone ; Terminal Care ; Training Support

PURPOSE: We investigated how intensive care unit (ICU) nurses understand the meaning of death, death anxiety, death concern and respect for life. METHODS: From November 2009 through February 2010, a survey was conducted on 230 nurses working at the ICU of 10 general hospitals located in Seoul and Gyeonggi province. Participants were asked to answer a questionnaire consisted of 67 questions under four categories of the meaning of death, death anxiety, death concern and respect for life. RESULTS: Participants scored 4.27 points on their understanding of the meaning of death, 4.43 on death anxiety, 4.12 on death concern and 4.18 on respect for life. Participants' meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' positive meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' negative meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' death anxiety was positively correlated with death concern and negatively with respect for life. Participants' death concern was negatively correlated with respect for life. CONCLUSION: Compared with nurses who served at ICU for a long time, nurses with less ICU experience scored lower on the meaning of death and respect for life, while they presented high anxiety and concern about death. A training course may help nurses develop their view on the meaning of death, which in turn would enhance their performance in caring dying patients.
Anxiety ; Hospitals, General ; Humans ; Critical Care ; Intensive Care Units ; Value of Life ; Surveys and Questionnaires

The purpose of this paper is to suggest a direction for future studies based on the analysis of the articles published in the Korean Journal of Hospice and Palliative Care from 1998 to 2012. A total of 240 articles (51 reviews, 189 original) were examined in three five-year groups. Categories of analysis include authors' background (profession, region) and general characteristics and qualitative aspects of the original paper (participants, topic, study design, data analysis, ethical consideration, multidisciplinary approach, research funds and sample size estimation). While the journal publishes more of articles than before, it is mainly due to the increase in the number of review articles, not original articles. As for study topics, healthcare industry and physical symptoms were most frequently studied. The disparity in authors' regional background is fading, and more articles are published by nurses than before. Moreover, more studies are funded while fewer papers tend to adopt a multidisciplinary approach or focus on care givers. Also, in terms of a study design, the number of experimental and methodological studies has slightly increased. In the qualitative aspect, studies considered ethical issues and collected participation consent, and fewer studies reported an estimated sample size. In data analysis, post-adjustment comparison decreased, and new analytical methods are increasingly used. Our results indicate the need to conduct research with more extensive scientific data in various fields of hospice and palliative care.
Caregivers ; Financial Management ; Health Care Sector ; Hospice Care ; Hospices ; Humans ; Palliative Care ; Sample Size ; Statistics as Topic

The objective of this paper is to suggest future goals and strategies for social work in hospice and palliative care in Korea by understanding its historical background. Both literature review and participant observation were performed to examine historical data relating to social work in hospice and palliative care in Korea. Also reviewed were the current trends with a focus on the roles of social workers in the said arena, qualifications, education, research and medical insurance policy. First of all, the roles of social workers do not appear to be clearly defined in the field of hospice and palliative care, which seems to lead to the lack of recognition as professional workers. The qualification standard for social workers in hospice and palliative care remains inadequate. Second, there seems to be insufficient professional social worker training resources, in terms of both the number of educators and training programs. Third, social workers in Korea produce significantly less publications than those in other professions. There is also a dearth of qualified evidence-based research that is needed to prove benefits of intervention and ultimately for policy implications. Last, the current medical insurance policy needs to be revised to secure fees for social work services and dedicated full-time social workers in hospice and palliative care. Korea needs to approach social work in hospice and palliative care with specific goals to develop future strategies. Related infrastructure and an executive structure should be established via networking and partnership with academic societies, associations and schools.
Fees and Charges ; Hospices ; Humans ; Insurance ; Korea ; Palliative Care ; Social Workers

PURPOSE: This study was to testify the effects on self esteem and spiritual well-being of holistic hospice nursing intervention program ("Rainbow program") for inpatients of hospice palliative care unit. This was designed as a preliminary experimental study with one-group pre-post test. METHODS: A total of 27 patients who were over 18 years old, and admitted in hospice palliative care unit of S hospital in P city, submitted informed consent for this study, participated in holistic hospice nursing intervention program(total 10 sessions and 1,200 minutes for 2 weeks) from April 6, 2004 to April 20, 2005. To test the effects of this intervention, Self Esteem Questionnaire (SEQ) and Spiritual Well-being Questionnaire were used. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. RESULTS: (1) Hypothesis No. 1 "The experimental group which received Rainbow program will have a higher degree of self esteem than before" was supported (t=11.554, P<0.001). (2) Hypothesis No. 2 "The experimental group which received Rainbow program will have a higher degree of spiritual well-being than before" was also supported (t=6.387, P<0.001). CONCLUSION: This Holistic Hospice Nursing Intervention Program was effective in increasing self-esteem and spiritual well-being of patients in hospice palliative care unit. Therefore, it can actively be used and also applied to hospice palliative care practice, research, and education as a useful model of interdisciplinary team approach by hospice professionals.
Evaluation Studies as Topic ; Hospices ; Humans ; Informed Consent ; Inpatients ; Palliative Care ; Self Concept ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to analyze the effect of death preparing education on death anxiety and meaning of life for volunteers. METHODS: Data collection and intervention were carried out from January 11 to 25, 2009. The subjects included 60 volunteers in Jeonju city, and they were divided into two groups; 30 each of experimental group and control group. Death preparing education program contained 5 steps. Data were analyzed with t-test, chi-square-test, and ANCOVA test with SPSS version 12.0. RESULTS: The death anxiety scores in the experimental group were significantly lower than in the control group (F=4.01, P=0.046). The meaning of life scores in the experimental group were significantly higher than in the control group (F=6.32, P=0.015). CONCLUSION: The death preparing education program for volunteers was confirmed to be an effective intervention to lessen death anxiety and to improve the meaning of life. Therefore, I strongly recommend that this program should generously be applied to volunteers.
Anxiety ; Data Collection

PURPOSE: Malignant bowel obstruction causes gastrointestinal symptoms and leads to diminished quality of life in patients with advanced cancer. Several studies have shown the efficacy of octreotide for the relief of malignant bowel obstruction-related symptoms. The aim of this study is to assess the efficacy and safety of octreotide in patients with malignant bowel obstruction. METHODS: We retrospectively reviewed medical records of twenty nine patients who had suffered from malignant bowel obstruction without clinical improvement of conservative care and subsequently, received octreotide treatment. Initial dosage of octreotide was 0.1 mg/day, and dose was escalated depending on the clinical effect. For each patient, we assessed visual analogue scale (VAS) of pain, number of vomiting episode, and amount of nasogastric tube drainage. RESULTS: Median dosage of octreotide was 0.2 mg/day (range 0.1~0.6), and median duration from initial medication to death was 20 days (range 2~103). VAS before and after octreotide treatment were 5.6+/-1.24, and 2.7+/-0.96, respectively. The numbers of vomiting episode before and after octreotide treatment were 3.6/day+/-2.5, and 0.4/day+/-0.8, respectively. The mean amounts of nasogastric tube drainage before and after octreotide treatment were 975+/-1,083 cc/day and 115+/-196 cc/day, respectively. Statistically significant reduction in VAS, the number of vomiting episode and the amount of nasogastric tube drainage were observed after octreotide treatment (P<0.05). CONCLUSION: Administration of octreotide in patients with malignant bowel obstruction, which is uncontrolled by other medication, was effective and safe. In such clinical situations, physicians should consider to add of octreotide for symptomatic control.
Drainage ; Humans ; Intestinal Obstruction ; Medical Records ; Octreotide ; Quality of Life ; Retrospective Studies ; Vomiting

The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.
Brief Psychiatric Rating Scale ; Humans ; Korea ; Pain Measurement ; Palliative Care ; Quality of Life ; Surveys and Questionnaires