PURPOSE: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. METHODS: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist. RESULTS: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death. CONCLUSION: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.
Catheterization ; Catheterization, Central Venous ; Catheterization, Peripheral ; Catheters* ; Delirium ; Hospice Care ; Humans ; Palliative Care ; Retrospective Studies ; Rivers ; Terminal Care ; Terminally Ill* ; Thrombosis

PURPOSE: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. METHODS: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. RESULTS: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE<24), depression (BDI> or =16), and insomnia (ISI> or =15) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. CONCLUSION: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.
Anxiety ; Delirium* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Hospice Care ; Hospices* ; Humans ; Logistic Models ; Proportional Hazards Models ; Psychometrics ; Risk Factors* ; Sleep Initiation and Maintenance Disorders ; Substance-Related Disorders ; Terminally Ill

PURPOSE: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. METHODS: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. RESULTS: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". CONCLUSION: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.
Busan ; Caregivers ; Curriculum ; Education ; Female ; Hospices ; Humans ; Nursing Care ; Nursing* ; Schools, Nursing ; Students, Nursing ; Terminal Care

PURPOSE: This study was conducted to investigate perception of good death among the community-dwelling elderly and identify factors related to the perception. METHODS: A questionnaire survey was carried out using a convenient sampling method (N=317). Data were analyzed by applying descriptive statistics, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient, and stepwise multiple regression. RESULTS: Participants scored an average of 3.35 on a 4-point scale for the perception level of good death. They scored higher on the factor of personal control that other factors affecting the perception. Good death was positively correlated with family support (r=0.252). Family support (beta=0.287) and gender (beta=0.197) significantly influenced the elderly's perception of good death. These variables accounted for 10.2% of the total variance. CONCLUSION: The results show that family support is an important factor for the perception of good death among the elderly. Therefore, family support should be carefully considered to ensure good death for more senior citizens. Our findings can be utilized to support programs such as death education for the elderly.
Aged* ; Attitude to Death ; Education ; Humans ; Surveys and Questionnaires

PURPOSE: There has been very little study on the associations between patient's symptoms themselves and family caregiver (FC)'s depression in the palliative phase. This cross-sectional study was to investigate the relationship between symptom features of terminally ill cancer patients and their FC's depression. METHODS: We performed a multicenter survey using the MD Anderson symptom inventory and the Hospital Anxiety and Depression Scale. A total of 293 patient-FC pairs were recruited from seven tertiary medical centers. A multivariate regression analysis was applied for identifying the relevant factors associated with FC depression and for estimating adjusted depression score of FCs. RESULTS: Among various psychosocial factors, low FC quality of life, low social support, spouse, and more caregiving time were significantly associated with FCs' depression. According to the presence of FCs' depression, there were significant differences in some symptom characteristics of patients. Even after adjusting for the relevant confounders, depression scores were lower in FCs caring for patients who had negative symptoms (loss of appetite, P=0.005; drowsiness, P=0.024; and dry mouth, P=0.043) than in FCs caring for patients who had not. FCs caring for patients with severe appetite loss had lower depression scores than those with not severe one (P=0.039). CONCLUSION: Our result suggests that patient's symptom characteristics might be helpful when evaluating a FC's depression.
Anxiety ; Appetite ; Caregivers* ; Cross-Sectional Studies ; Depression* ; Humans ; Mouth ; Psychology ; Quality of Life ; Sleep Stages ; Spouses ; Symptom Assessment ; Terminal Care ; Terminally Ill*

PURPOSE: From August 2017, hospice-palliative care (HPC) will be provided to patients with acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and liver cirrhosis in Korea. To contribute to building a non-cancer (NC) hospice-palliative care model, NC specialists were interviewed regarding the goals, details, and provision methods of the model. METHODS: Four physicians specializing in HPC of cancer patients formulated a semi-structured interview with questions extracted from literature review of 85 articles on NC HPC. Eleven NC disease specialists were interviewed, and their answers were analyzed according to the qualitative content analysis process. RESULTS: The interviewees said as follows: It is difficult to define endstage NC patients. HPC for cancer patients and that for NC patients share similar goals and content. However, emphasis should be placed on alleviating other physical symptoms and emotional care rather than pain control. Timing of the care provision should be when patients are diagnosed as “end stage”. Special issues should be considered for each NC disease (e.g., use of anti-retroviral drugs for AIDS patients, oxygen supply for COPD patients suffering from dyspnea, liver transplantation for patients with liver cirrhosis) and education should be provided to healthcare professionals. NC patients tend to negatively perceive HPC, and the government's financial assistance is insufficient. CONCLUSION: It is necessary to define end-stage NC patients through in-depth discussion to minimize issues that will likely accompany the expansion of care recipients. This requires cooperation between medical staff caring for NC patients and HPC givers for cancer patients.
Acquired Immunodeficiency Syndrome ; Delivery of Health Care ; Dyspnea ; Education ; Hospices ; Humans ; Korea* ; Liver Cirrhosis* ; Liver Transplantation ; Liver* ; Medical Staff ; Oxygen ; Palliative Care ; Pulmonary Disease, Chronic Obstructive* ; Qualitative Research ; Specialization

On Aug 4, 2017, the new legislation of ‘Act on Hospice & Palliative Care and Patient Determination of Life Sustaining Treatments’ was enforced. Compared with articles about the hospice & palliative care of ‘National Cancer Act’, it should be helpful to update the change points.
Hospice Care ; Hospices* ; Humans ; Life Support Care ; Palliative Care*

End-stage liver disease (ESLD) is a terminal condition of cirrhosis which cannot be treated without liver transplantation. Thus, it is natural for patients to consider hospice/palliative care (HPC). Since the recent legislation of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (Act No. 14013) in Korea, the practicality of this law has become an issue. The criteria for HPC should be defined with consideration to how the severity of each ESLD complication may vary by individual patients. Generally, patients qualify if they have an intractable condition despite aggressive treatment such as the hepatorenal syndrome, hepatic encephalopathy or variceal hemorrhage. However, the option of liver transplantation should be sufficiently discussed with patients and their families before making a decision on HPC. The evaluation of which ESLD patients should receive HPC should be based on a long-term doctor-patient relationship and sufficient objective data. Therefore, a multidisciplinary approach and mutual consultation among cirrhosis specialists and doctors with other expertise are essential to offer optimal and balanced treatments between liver-specific treatment and HPC. Discussed in this review are adequate criteria for HPC and special considerations for ESLD at the point of HPC.
End Stage Liver Disease* ; Fibrosis ; Hemorrhage ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Hospice Care ; Hospices* ; Humans ; Jurisprudence ; Korea ; Liver Diseases ; Liver Transplantation ; Palliative Care* ; Specialization ; Transplantation

According to the advance of antiretroviral regimen and the early treatment strategy, people living with human immunodeficiency virus (PLWH) are achieving the goal of virologic suppression and immune restoration. Most of them no more die of acquired immunodeficiency syndrome (AIDS) defining illnesses, and become older with chronic comorbidities such as cardiovascular, metabolic, hepatic, renal and neurological diseases. However some PLWH still visit hospitals as late presenters with very low CD4+ T cell counts, so that they suffer AIDS defining illnesses to die or experience severe neurological complications resulting in disabilities. Early palliative interventions are needed on the various symptoms of PLWH. Thus far chronic pains such as distal symmetric sensory polyneuropathies have been underevaluated. Active pain-relieving interventions are important to them. Recently we define end of life condition of human immunodeficiency virus (HIV) or eligibility to hospice care after adjusting current status of HIV treatment. Hospice teams should pay attention to the specific medical conditions, psychological needs, and social circumstances of PLWH. With just standard precautions as common infection control measures, general hospice cares can be provided to them like to other hospices subjects. For giving PLWH opportunities to have the end of life with value and dignity, hospice multidisciplinary team should intervene them early and aggressively. Now we need more clinical experiences and institutional improvements.
Acquired Immunodeficiency Syndrome ; Cell Count ; Chronic Pain ; Comorbidity ; HIV* ; Hospice Care ; Hospices* ; Infection Control ; Palliative Care* ; Polyneuropathies

PURPOSE: This study was conducted to examine how nurses' death anxiety and terminal care stress affect their terminal care performance in the clinical setting. METHODS: The study enrolled 180 registered nurses with experience of attending dying patients at a university hospital located in Seoul, Korea. Collected data were analyzed with descriptive statistics, one-way ANOVA and Pearson's correlation using SPSS 18.0 for Windows. RESULTS: Nurses showed significant differences in the level of death anxiety and terminal care stress as well as terminal care performance by working division, marital status, educational background and hospice training. A significant relationship was found between terminal care stress and terminal care performance. CONCLUSION: The study results showed that efforts to ease nurses' death anxiety and terminal care stress could improve their terminal care performance. Further study should be conducted to investigate other factors that affect nurses' terminal care performance from various perspectives and develop a terminal care manual which can be used as guidance for nurses in charge of terminal patient care.
Anxiety ; Fees and Charges ; Hospices ; Humans ; Korea ; Marital Status ; Nursing Services ; Patient Care ; Terminal Care