Preserving dignity is a significant concern for individuals approaching the end of their lives, as they face an increasing number of conditions that can potentially compromise their dignity. This article discusses dignity therapy as one intervention method aimed at enhancing the psychological and spiritual well-being of patients with terminal illnesses. Dignity therapy is an empirically supported therapeutic intervention that interviews patients with nine questions about what is important to them and what they want to remember, culminating in the production of a document based on these conversations. This intervention serves as a valuable tool and framework, enabling clinical professionals to reflect on dignity. It also provides clinicians with a medium to connect with patients on a deeply human level.

Many terminally ill cancer patients grapple with a range of physical, psychological, and social challenges. Therefore, it is critical to offer effective psychological interventions to assist them in managing these issues and enhancing their quality of life. This brief communication provides a concise overview of acceptance and commitment therapy (ACT), along with empirical evidence of its application for patients, caregivers, and healthcare professionals in hospice and palliative care settings and an overview of future directions of ACT interventions in South Korea. ACT, a third-wave type of cognitive behavioral therapy, is a model of psychological flexibility that promotes personal growth and empowerment across all life areas. Currently, there is substantial evidence from overseas supporting the effectiveness of ACT on health-related outcomes among patients with various diseases, caregivers, and healthcare professionals. The necessity and significance of conducting ACT-based empirical research in hospice and palliative care settings in South Korea are discussed.

Purpose: This study aimed to analyze interventions for bereaved families and evaluate their effectiveness, with the ultimate goal of supporting evidence-based nursing for bereaved families. Methods: Research trends were identified based on a search of domestic databases from January 2000 to December 2022, and a meta-analysis was conducted on interventions for bereaved families. Forty-five papers were selected, and information was extracted on participants, research design, and interventions. A meta-analysis of seven papers was performed, and the effect size was calculated. Results: Fourteen papers dealt with interventions for middle-aged women who had lost their spouses, 20 used qualitative research methods, and 20 were on art therapy programs. Thirty studies had fewer than 10 participants, and most interventions had 60~120 minutes per session and 9~16 sessions in total.There were seven randomized controlled trials, and all studies included in the quality evaluation showed a low risk of bias. Four papers measured grief as an outcome, and the effect size was -1.9577 (95% CI: -2.9206 to -0.9947), indicating that the treatment significantlydecreased grief (P＜0.001). Six papers measured depression as an outcome, and the effectsize was -1.6775 (95% CI: -2.1835 to -1.1716), showing that the treatment significantly decreased depression (P＜0.001). Conclusion Intervention programs for bereaved families were shown to be effective in relieving grief and depression. However, programs should be developed that target middle-aged men who have lost their spouses and children who have lost their parents. Randomized controlled trials should also be conducted on interventions to reduce grief and depression.

Purpose: This study investigated knowledge, attitudes, and nursing stress related to lifesustaining treatment among oncology nurses. Methods: A descriptive study design was used. Data were collected through a survey from April 1 to May 31, 2022. The participants were 132 nurses working in the oncology ward of a tertiary hospital in Seoul. Data were analyzed using the SPSS 25.0 program with descriptive statics, the independent t-test, analysis of variance, and Pearson correlation coefficients. Results: The average scores for knowledge, attitudes, and nursing stress related to life-sustaining treatment were 14.42, 3.29, and 3.96, respectively. Significant differences in knowledge about life-sustaining treatment were observed based on clinical experience (P=0.029) and education about life-sustaining treatment (P=0.044). Attitudes toward life-sustaining treatment varied significantly with education about life-sustaining treatment (P=0.014), while stress levels differed significantly across working units (P=0.004). A positive correlation was found between the dilemma of extending or stopping life-sustaining treatment (a subdomain of nursing stress) and attitudes toward life-sustaining treatment (r=0.260, P=0.003). Conclusion There was no significant correlation between the nursing stress experienced by oncology nurses and their knowledge and attitudes toward life-sustaining treatment. However, a more positive experience with life-sustaining treatment education was associated with higher stress levels related to the dilemma of extending or stopping life-sustaining treatment. Therefore, it is crucial to develop strategies to manage this dilemma and reduce stress in the field.

Purpose: This study aimed to identify levels of perception and performance of end-oflife care among nurses and to investigate correlations between perception and performance. Methods: This cross-sectional descriptive survey included 321 nurses from a tertiary hospital in Seoul, Korea. The participants had at least 6 months of work experience and had been involved in end-of-life care at least once, in either ward or intensive care unit settings.A structured questionnaire was utilized to assess their perception and performance of endof-life care. Results: The mean score for perception of end-of-life care was 3.23±0.34, while the score for performance of end-of-life care was 3.08±0.34. There was a significant positive correlation between nurses’ perception of end-of-life care and their performance in this area (r=0.78, P＜0.001). Conclusion It is necessary to change perceptions regarding end-of-life care and to develop systematic and standardized education programs including content such as assessing the hydration status of dying patients, evaluating mental aspects such as suicidal ideation, and providing spiritual care for nurses working in end-of-life departments.

Although most patients prefer dying at home, patients whose condition rapidly becomes critical need care in the intensive care unit (ICU), and it is rare for them to die at home with their families. Therefore, interest in hospice and palliative care for patients in the ICU is increasing. Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU: patients with chronic critical illnesses who need tracheostomy, percutaneous gastrostomy tube, and extracorporeal life support; patients aged 80 years or older; stage 4 cancer patients; patients with specific acute diseases with a poor prognosis (e.g., anoxic brain injury and intracerebral hemorrhage requiring mechanical ventilation); and patients for whom the attending physician expects a poor prognosis. There are two PC models—a consultative model and an integrative model—in the ICU setting. Since these two models have advantages and disadvantages, it is necessary to apply the model that best fits each hospital’s circumstances. Furthermore, interdisciplinary decision-making between the ICU care team and PC specialists should be strengthened to increase the provision of hospice and palliative care services for patients expected to have poor outcomes and their families.

The combination of oxycodone and naloxone is useful for cancer pain management. Naloxone, as a pure opioid antagonist, cannot be used simultaneously with opioids. However, owing to its low bioavailability, it can be used in an oral composite formulation. We present the case of a 55-year-old man with gastric cancer who experienced severe opioid withdrawal syndrome (OWS) triggered by oxycodonealoxone that was successfully managed with dexmedetomidine. He had been in a stable condition on intravenous morphine to alleviate cancer pain. Intravenous morphine was switched to oral oxycodonealoxone for discharge from the hospital. The patient suddenly developed restlessness, heartburn, and violent behavior 30 minutes after taking oxycodonealoxone. We attempted sedation with midazolam and propofol, but paradoxical agitation and desaturation occurred. Next, we tried dexmedetomidine and the patient showed a decreased heart rate and reduced agitation. The patient was eventually stabilized by increasing the dose of dexmedetomidine. This report informs clinicians of the possibility of OWS when switching from opioids to oxycodonealoxone, which can be overcome with the appropriate use of sedatives and dexmedetomidine depending on the patient’s condition.

Purpose: The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). Methods: We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Results Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. onclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a nonmalignant lung disease, because the characteristics of the respective diseases differ, end-oflife care practices and hospice approaches must be considered differently.

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 endof-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.

With the implementation of Act on Hospice and Palliative Care and Decisions on LifeSustaining Treatment for Patients at the End of Life, interests of the general public on selfdetermination right and dignified death of patients have increased markedly in Korea.However, “self-determination” on medical care is misunderstood as decision not to sustain life, and “dignified death” as terminating life before suffering from disease in terminal stage. This belief leads that physician-assisted suicide should be accommodated is being proliferated widely in the society even without accepting euthanasia. Artificially terminating the life of a human is an unethical act even though there is any rational or motivation by the person requesting euthanasia, and there is agreement thereof has been reached while there are overseas countries that allow euthanasia. Given the fact that the essence of medical care is to enable the human to live their lives in greater comfort by enhancing their health throughout their lives, physician-assisted suicide should be deemed as one of the means of euthanasia, not as a means of dignified death. Accordingly, institutional organization and improvement of the quality of hospice palliative care to assist the patients suffering from terminal stage or intractable diseases in putting their lives in order and to more comfortably accept the end of life physically, mentally, socially, psychologically and spiritually need to be implemented first to ensure their dignified death.