PURPOSE: This study was designed to systematically explore and elicit information about terminally ill cancer patients' and primary family caregivers' subjectivity of death. METHOD: Using Q-methodology, 21 terminally ill cancer patients and 19 primary family caregivers sorted 40 statements during personal interviews. RESULTS: The results of this study show that terminally ill cancer patients have four factors ('Attachment to life', 'Hope for heaven', 'Resignation to reality', 'Avoidance of pain') of response and primary caregivers have four factors('Dependence on religion', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality'). Comparing the subjectivities of death of terminally ill cancer patients and primary family caregivers, 'Hope for heaven' and 'Dependence on religion' reveal the similarities of their outlook. On the other hand, 'Attachment to life', 'Resignation to reality', 'Avoidance of pain', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality' reveals different aspects of their outlook. The group of terminally ill cancer patients and their families divided into four types. Type A was 'Attachment to life and Agony of reality', type B was 'Attachment to life and Obedience to fate', type C was 'Hope for heaven and Dependence on religion' and type D was 'Resignation to reality and Faithfulness to reality'. The positive group was C or 'Hope for heaven and Dependence on religion'. CONCLUSION: There are significant differences found in the subjective structure of death among terminally ill cancer patients and primary family caregivers. Therefore, it is necessary to develop an individualized nursing intervention for terminally ill cancer patients and family caregivers.
Caregivers* ; Hand ; Humans ; Nursing ; Terminally Ill*

PURPOSE: This study was designed to systematically explore and elicit information about terminally ill cancer patients' and primary family caregivers' subjectivity of death. METHOD: Using Q-methodology, 21 terminally ill cancer patients and 19 primary family caregivers sorted 40 statements during personal interviews. RESULTS: The results of this study show that terminally ill cancer patients have four factors ('Attachment to life', 'Hope for heaven', 'Resignation to reality', 'Avoidance of pain') of response and primary caregivers have four factors('Dependence on religion', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality'). Comparing the subjectivities of death of terminally ill cancer patients and primary family caregivers, 'Hope for heaven' and 'Dependence on religion' reveal the similarities of their outlook. On the other hand, 'Attachment to life', 'Resignation to reality', 'Avoidance of pain', 'Faithfulness to reality', 'Obedience to fate', 'Agony of reality' reveals different aspects of their outlook. The group of terminally ill cancer patients and their families divided into four types. Type A was 'Attachment to life and Agony of reality', type B was 'Attachment to life and Obedience to fate', type C was 'Hope for heaven and Dependence on religion' and type D was 'Resignation to reality and Faithfulness to reality'. The positive group was C or 'Hope for heaven and Dependence on religion'. CONCLUSION: There are significant differences found in the subjective structure of death among terminally ill cancer patients and primary family caregivers. Therefore, it is necessary to develop an individualized nursing intervention for terminally ill cancer patients and family caregivers.
Caregivers* ; Hand ; Humans ; Nursing ; Terminally Ill*

Disclosure of a diagnosis of cancer to patients is a major problem among physicians in Korea. Many questions arise when considering issues involved in telling the diagnosis of cancer beyond the question of whether to tell. But there has been no consensus guideline on how, and in what context, to tell the diagnosis of cancer to the patients. The review of the literature reveals that the attitudes of physicians on the truth telling have been changing from favoring non-disclosure to disclosure over time. The disclosure rate was 81.8% in a Korean survey performed in 1990, while it was 65% in a survey in 1979. The younger the patient's age was, the higher the disclosure rate was. This tendency was same in Korean nurses and patients. The majority of Korean patients wanted their doctors to break the bad news, not only because the patients wanted to obtain detailed information about their conditions but also because they believed their doctors. They also wanted their family to hear the truth first, immediately after the diagnosis had been confirmed. The most important issue in the process of disclosing a diagnosis of cancer to patients is truth. Otherwise, doctors will lose the chance to give help to the patients when they are in real need of doctor's help at the very end of their lives.
Consensus ; Diagnosis* ; Disclosure ; Humans ; Korea ; Terminally Ill*

PURPOSE: The purpose of the study was to investigate how much understand about artificial hydration in patients with terminal cancer, according to the subject groups, including patients, families, and general public. METHODS: Data were collected from June 2007 to December 2007 and the participants included 22 hospitalized patients in the hospice unit of S Hospital, 100 families, and 101 participants who participated in a hospice education program for the general public. The questionnaire was developed through literature review, interview with patients' families, and expertise consultation. Data were analyzed using descriptive statistics with an SAS program. RESULTS: Understanding of artificial hydration among patients, families and general public was examined from three perspectives. From an ethical perspective, 'if you receive artificial hydration, you can live longer', 45.5%, 63%, and 52.4% of the above three groups, respectively, answered "yes". From an emotional perspective, 'artificial hydration must be provided', 81.8%, 70% and 58.4%, respectively, agreed. From a cultural perspective, 'if artificial hydration is not provided for the patient, the families will feel painful', 95.5%, 83%, and 88.2%, respectively, answered "yes". CONCLUSION: This study found the differences in understanding of artificial hydration among patients, families and general public, and also found that less than 50 percent of the participants understood artificial hydration appropriately. We suggest, therefore, that patients' understanding about artificial hydration should be determined in the clinical setting and then followed by individualized education according to given medical situations.
Fluid Therapy ; Hospices ; Humans ; Phenothiazines ; Terminally Ill ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to examine the effects of music therapy on pain, depression, and anxiety in terminally ill patients. METHODS: Twenty patients in the experimental group were provided with music via headphones for 30- 40 min at a time as they requested for 2 weeks, whereas no music was provided for the nineteen patients in the control group. Data were collected using a questionnaire. The research instruments included Visual Analog Scale (VAS) and Depression & Anxiety Inventory Scale. Data were analyzed using chi-square-test, t-test, and Fisher's exact test, using SPSS 15.0. RESULTS: There were significant decreases in the scores of pain at present (t=-2.54, p<.05), depression (t=-2.187, p<.05) and anxiety (Z=-2.114, p<.05) in the experimental group compared to those in the control group. CONCLUSION: Music therapy is considered non-invasive and inexpensive intervention and can be easily applied to alleviate pain, depression and anxiety for terminally ill patients.
Anxiety ; Depression ; Humans ; Music ; Music Therapy ; Surveys and Questionnaires ; Terminally Ill

BACKGROUND: Accurate prediction of survival in terminal cancer patients is important for planning effective palliative care. But, the prediction of survival most often relies on the physicians' prediction. Recently, simple prognostic scores such as Palliative Prognostic Index and Palliative Prognostic Score have been developed to estimate duration of survival. The aim of this study was to validate these prognostic scores and physicians' prediction for terminally ill cancer patients in Korea to determine its value in clinical practice. METHODS: The subjects of this study were 40 terminal cancer inpatients of one hospital who died between March to May 2005. All patients' Palliative Prognostic Index, Palliative Prognostic Score, and physicians' prediction were recorded on admission by a physician. RESULTS: When a Palliative Prognostic Index of more than 6 was adopted as a cut-off point 3 weeks' survival was predicted with a sensitivity of 90% and a specificity of 60%. When the three groups were grouped by Palliative Prognostic Scores (group A: < or =5.5, group B: 5.6~11, group C: >11), the 30 day survival probability were 60% for group A, 16.7% for group B, and 4.3% for group C, respectively. Physicians' prediction showed moderate correlation (correlation coefficient=0.604) with actual survival and had a tendency to overestimate survival. CONCLUSION: Palliative Prognostic Index was proved to be a reliable survival prediction tool in Korea. Palliative Prognostic Score had a tendency to overestimate survival as compared with other studies. Physicians' prediction had a correlation with actual survival, and it was presumed to be more accurate when combined with other prognostic score.
Humans ; Inpatients ; Korea* ; Palliative Care ; Prognosis ; Sensitivity and Specificity ; Terminally Ill

PURPOSE: The purpose of this study is to analyze types of shared medical decision making by health professionals in a decision making position. METHODS: The Q-methodology was used. Q sample was constructed with a total of 35 Q-statements that were offered with a 9-point rating scale. The statements were structured to generate answers that would form a shape of a normal distribution. Answers to Q sample were analyzed using a QUANL PC program. RESULTS: Four types of shared medical decision making were identified. Type I is patient-centered decision making, Type II is physician-centered, Type III is health professional-centered and Type IV is patient-family-centered. CONCLUSION: Study results indicate that it is recommended to develop an education program based on the four types of shared medical decision making so that health professionals can be provided with different approaches according to their decision making style.
Decision Making* ; Education ; Health Occupations ; Humans ; Terminally Ill*

With development of new techniques for medical intervention, there has been a big dilemma for physicians about their decision when to stop treatment. Application of life-sustaining device sometimes results in a prolongation of painful period (dying process) for patients. Regarding the role of physician in the end-of-life decision, there could be two extremes : euthanasia vs. therapeutic tenacity (futility or accanimento terapeutico). Either extreme has its own limitations. One of possible solutions is an appropriate application of withholding and withdrawing interventions. However, several considerations are necessary for this. First, the clinical aspect of decision is whether a certain management is proportionate or non-proportionate for a given situation. If there is a chemotherapy regimen that has an efficacy of 15% partial response rate with side effects in the previous study, is it propotionate or non-proportionate treatment for advanced cancer patients? Other aspects of decision is regarding ethical, economical, and legal issues. One type of circumstances that may prompt claims of futility is the discrepancy between the values or goals of involved parties. Other concerns on futility issues are ① is it easy to break the bad news to dying patients in Korean culture? (communication problems at various levels) ② is social welfare system adequate enough not to interfere with a fair decision? Values on the issues like therapeutic decision and withholding life-sustaining treatments in terminally ill cancer patients are discordant between physicians and family members. To resolve controversies on the role of physicians as well as those of patients and their family members should be considered in the final decision.
Drug Therapy ; Euthanasia ; Humans ; Medical Futility ; Social Welfare ; Terminally Ill*

PURPOSE: This study was conducted to identify subjective attitudes towards terminal patients in nursing students who had clinical practice. The types of subjective attitude were classified by applying Q methodology. According to those types, basic reference data for the development of educational programs were provided.METHODS: Thirty-four final Q samples were selected, and Q classification with a nine-point scale was performed with P samples of 43 nursing students. A key factor analysis was conducted with the collected data using the PC QUANAL program.RESULTS: Nursing students' attitudes towards terminal patients were grouped into three types. The total variable was 49.96%. Students with Type 1 (“wish for life-sustaining medical treatment”) thought that terminal patients accurately understood their medical condition and wanted to prolong their lives. Others with Type 2 (“need for service and support”) believed that a multidisciplinary nursing system needs to be established to help terminal patients prepare for death. Students with Type 3 (‘awareness and acceptance of death’) thought that terminal patients wanted to die with dignity at a hospice unit.CONCLUSION: This study analyzed various types of attitude towards terminal patients, as perceived by nursing students with clinical training experience. Development of educational programs for each attitude type analyzed in this study could contribute to systematic training programs for nursing students caring for terminal patients.
Classification ; Education ; Hospices ; Humans ; Nursing ; Students, Nursing ; Terminally Ill

This study has been done for the purpose of investigating the degrees of death orientation and terminal care performance. The factors related to these two variables, and the relationship between death orientation and terminal care performance. The subjects of study were 128 nurses who implemented nursing care for terminally ill patients at C University Hospital in Kwang Ju city. The date were collected from March 13 to 19, 1996, by means of Death Orientation by Thorson Powell(1988) and Terminal Care Performance Scale by researcher. The data were analysed by t-test, ANOVA, Duncan test and Pearson's correlation coefficient. The Results of this study were summarized as follows; 1. The mean score of death orientation was 61.4. The degree of death orientation showed no significant difference depending on the general characteristics of nurses. 2. The mean score of terminal care performance was 45.5. In comparison of the degree of terminal care performance among three domains, the mean score of each item tended to show higher degrees in order of'Psychological domain(2.4)','Physical domain(2.2)',' Spiritual domain(1.9)'. 3. The degree of terminal care performance showed significant differences in age (F=11.48 p=.0001), marital status(t=10.49 p=.0015), religion(t=5.01 p=.0270), period of clinical experience(F=10.30 p=0.0001) and ward unit(F=3.73 p=.0036). The degree of terminal care performance in physical domain showed significant differences in age (F=7.26 p=.0010), marital status(t=9.72 p=.0023), period of clinical experience(F=7.03 p=.0013), ward unit(F=6.23 p=.0001). The degree of terminal care performance in psychological domain showed significant differences in age(F=8.73 p=.0003), marital status (t=4.22 p=.0419), religion(t=5.59 p=.0196), period of clinical experience(F=6.36 p=.0023), ward unit(F=3.33 p=.0075). The degree of terminal care performance in spiritual domain showed significant differences in age(F=8.30 p=.0004), marital status(t=10.45 p=.0016), religion(F=5.41 p=.0216), period of clinical experience(F=8.80 p=.0003). 4. The relationship between the degrees of death orientation and terminal care performance showed no correlation(r=-.026 p=.7746).
Gwangju ; Humans ; Marital Status ; Nursing Care ; Terminal Care* ; Terminally Ill