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Bedside Teaching of Relaxation Technique for Terminal Cancer Patients Treated with Radiation Therapy.

Sang Won KIM ; Mison CHUN ; Hyo Shin KIM

Korean Journal of Hospice and Palliative Care.2016;19(3):256-261. doi:10.14475/kjhpc.2016.19.3.256

Radiation therapy is an effective modality to alleviate cancer-related symptoms. To deliver radiation accurately, it is essential to secure stability of the treatment position in patients during each treatment time. However, some patients could be less cooperative due to their psychoemotional issues. We present two cases of terminal-stage cancer patients who were initially unable to lie still on the treatment table before simulation. A relaxation technique was taught to them on the bed, and they could relax and undergo radiation therapy with effective symptom relief.
Humans ; Integrative Medicine ; Posture ; Radiotherapy ; Relaxation*

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Factors Associated with Ketamine Use in Pancreatic Cancer Patient in a Single Hospice Center.

Kyung Min KWON ; Yong Joo LEE ; Chang Jin CHOI ; Chul Min KIM ; Jo Hi YOON ; Min Hee KIM

Korean Journal of Hospice and Palliative Care.2016;19(3):249-255. doi:10.14475/kjhpc.2016.19.3.249

PURPOSE: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. METHODS: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. RESULTS: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. CONCLUSION: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.
Hospices* ; Humans ; Ketamine* ; Medical Records ; Morphine ; N-Methylaspartate ; Neuralgia ; Palliative Care ; Pancreatic Neoplasms* ; Retrospective Studies

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Development of Audio-visual Aids of Death Education for Hospice Patients and Their Families.

Mi Suk SEO ; Yu Jung KANG ; Ji Yoon YOON ; Tae Yeon KIM ; Hye Jun CHO ; So Yeon PARK ; Si Yeon LEE ; Ji Hye JANG ; Yu Jin KIM ; Mi Teum KANG

Korean Journal of Hospice and Palliative Care.2016;19(3):240-248. doi:10.14475/kjhpc.2016.19.3.240

PURPOSE: Patients and their caretakers need to understand various problems and requirements in the dying process so that they may prepare for death for the rest of their remaining life. Accordingly, a systematic audio-visual resource was developed to educate hospice patients and their families at the palliative care ward about the process of dying. METHODS: For the development of an audio-visual resource, a initial education material was produced in the form of simple and accessible Power Point handouts based on literature study. Then, the program was completed through five rounds of a process, including expert advice, revision, update and evaluation. RESULTS: The final version of the program was filmed with cooperation of the medical literature information division. Using the program, patients and families were educated through five phases over three sessions for a total 26 minutes and 34 seconds. CONCLUSION: The significance of this study lies in the fact that it was conducted after the establishment of the palliative care ward, which made it easier for nurses provide the education. It is expected that the program may be used by hospice specialists as well as nurses as an education resource for hospice patients and their families.
Audiovisual Aids* ; Education* ; Hospices* ; Humans ; Palliative Care ; Specialization

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Factors Affecting Research Participation of Bereaved Families of Terminal Cancer Patients: A Prospective Preliminary Study.

Ye Won KIM ; Yuntaek LEE ; In Cheol HWANG ; Sun Wook HWANG ; Hyo Min KIM ; Jae Yong SHIM ; Youn Seon CHOI ; Yong Joo LEE

Korean Journal of Hospice and Palliative Care.2016;19(3):233-239. doi:10.14475/kjhpc.2016.19.3.233

PURPOSE: Little is known regarding the factors associated with the willingness of family caregivers of terminal cancer patients to participate in a bereaved survey. This study aimed to ascertain the pre-loss factors that predict actual participation in a bereaved survey. METHODS: We conducted a prospective observational study using data from two multi-center surveys at the end-of-life and after loss. In order to identify the pre-loss factors associated with participating in the bereaved survey, we used a step-wise multivariate logistic regression analysis. RESULTS: Among 185 bereaved individuals, 30 responded to the survey (response rate: 16.2%). There were differences between the participation group and the non-participation group regarding religion, economic status, and perceived quality of care as assessed by the Quality Care Questionnaire-End of Life. A final multivariate model revealed that bereaved individuals who professed a religion (adjusted odds ratio [aOR]=5.01; P=0.008), had a high income (aOR=4.86, P=0.003), and satisfied with the care for familial relationship (aOR=4.49, P=0.003) were more likely to engage in the bereaved survey. CONCLUSION: Our finding suggests that improving the quality of end-of-life care may promote actual participation in a bereaved survey through easing post-loss distress. More attention should also be paid to those bereaved individuals who are hesitant to participate in a bereaved survey.
Bereavement ; Caregivers ; Hospice Care ; Humans ; Logistic Models ; Observational Study ; Odds Ratio ; Prospective Studies* ; Surveys and Questionnaires

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Factors Influencing Perception of Hospice Palliative Care in High School Students in Korea.

Young Eun LEE ; Mi Kyung KIM ; Eun Ah CHOI ; Min Suk IM

Korean Journal of Hospice and Palliative Care.2016;19(3):222-232. doi:10.14475/kjhpc.2016.19.3.222

PURPOSE: This study was to investigate the relationships between spiritual well-being, attitude towards death and perception of hospice, and the factors influencing hospice perception of high school students. METHODS: A survey was conducted with 229 students in four high schools in B city from May 1, 2015 through May 31, 2015. The data were analyzed with descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, stepwise multiple regression using the SPSS 18.0 program. This study was approved by the internal review board. RESULTS: The factors influencing hospice perception of the high school students were previous recognition of hospice (β=0.412, P<0.001), attitude towards death preparation among sub-variables of attitude towards death (β=-0.244, P<0.001), subjective school life satisfaction (β=-0.215, P<0.001), and sex (β=0.191, P<0.001). The more positive the attitude towards my body after death and that towards death preparation was, the more positive recognition for hospice was. The total explanatory power of these factors was 34.5%. CONCLUSION: To improve high school students' perception of hospice, it is necessary to provide them with a hospice education program to help them with their attitudes towards death preparation and their understanding of hospice.
Adolescent ; Attitude to Death ; Education ; Hospice Care ; Hospices* ; Humans ; Korea* ; Palliative Care* ; Spirituality

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Dignity Therapy for End-stage Patients: Concept Analysis.

Bokyae CHUNG ; Eunhee OH

Korean Journal of Hospice and Palliative Care.2016;19(3):211-221. doi:10.14475/kjhpc.2016.19.3.211

PURPOSE: Dignity therapy is a very effective intervention to improve the dignity of end-stage patients. A concept analysis by Walker and Avant (2005) was adopted to define, describe, and delimitate the concept of dignity therapy. METHODS: Nursing literature in the National Digital Science Links (NDSL) and Medline database were searched for the definitions of "dignity" and "dignity therapy". Definitions, uses, and defining attributes of dignity therapy were identified; model and contrary cases were developed; and antecedents, consequences, and empirical references were determined. RESULTS: Through dignity therapy patients and their families share their stories, and that in turn improves the quality of life and death. Five attributes were identified: higher quality of life and death, therapeutic conversation, respect of human dignity and worth, expressing thoughts about life and death and systematic process. CONCLUSION: Patients at the end of their lives feel more comfortable about death. Hospice care providers should try to protect dignity of patients in their care. The attributes of the dignity therapy clarified in this study should be applied for terminally ill patients to improve their quality of life and death.
Hospice Care ; Hospices ; Humans ; Nursing ; Personhood ; Quality of Life ; Terminally Ill ; Walkers

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Delirium Management: Diagnosis, Assessment, and Treatment in Palliative Care.

Min Seok SEO ; Yong Joo LEE

Korean Journal of Hospice and Palliative Care.2016;19(3):201-210. doi:10.14475/kjhpc.2016.19.3.201

Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.
Antipsychotic Agents ; Benzodiazepines ; Dehydration ; Delirium* ; Dementia ; Depression ; Diagnosis* ; Early Diagnosis ; Education ; Haloperidol ; Humans ; Mortality ; Palliative Care* ; Prevalence ; Quality of Life ; Quetiapine Fumarate ; Risperidone

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Changes of Nursing Activities on Patients with DNR Orders.

Ji Yun LEE ; Jae In JANG

Korean Journal of Hospice and Palliative Care.2017;20(1):46-57. doi:10.14475/kjhpc.2017.20.1.46

PURPOSE: The purpose of this study is to identify the changes to nursing activities of nurses on patients with DNR (Do-Not-Resuscitate) order and factors associated to the changes. METHODS: Data were collected using a structured questionnaire for 173 nurses at general hospitals. Logistic regression analysis was performed on the data using SAS 9.4. RESULTS: With 39 nursing activities, an average of 60.4 (34.9%) nurses reported an increase in the activities, 102.4 (59.2%) no change and 10.1 (5.9%) a drop. The activity increase was the greatest in the social area, and the physical area was where the activities decreased the most. The activity increase was associated knowledge competency (9 items), attitudes (2 items), practical competency (4 items) and work load (14 items were). CONCLUSION: To offer systematical care for DNR patients, it is necessary to expand nurses' knowledge through end-of-life education and adjust their workload and provide a support system at the department level.
Education ; Hospitals, General ; Humans ; Logistic Models ; Nursing Care ; Nursing* ; Resuscitation Orders ; Terminal Care

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Death Anxiety and Terminal Care Performance of Nurses at Long Term Care Hospitals.

La Jin LEE ; Hyoung Sook PARK

Korean Journal of Hospice and Palliative Care.2017;20(1):37-45. doi:10.14475/kjhpc.2017.20.1.37

PURPOSE: The purpose of this study was to identify the relationships between death anxiety and terminal care performance of nurses at long term care hospitals. METHODS: Data were collected from 148 nurses working at 12 long term care hospitals in Busan from March 16, 2016 through May 16, 2016. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Scheffé test and Pearson's correlation coefficient with SPSS 18.0 for Windows. RESULTS: Terminal care performance was positively correlated with anxiety about other people's death (r=0.310, P≤0.001) and that of their own death (r=0.250, P=0.002). CONCLUSION: It appears necessary to develop a systematical educational program for terminal care nurses of to reduce their death anxiety and improve their terminal care performance.
Anxiety* ; Busan ; Long-Term Care* ; Terminal Care*

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The Prayer Experiences of Patients with End-Stage Cancer.

SoonBok Esther PARK ; Won Hee LEE ; Kyong Hwan OH

Korean Journal of Hospice and Palliative Care.2017;20(1):26-36. doi:10.14475/kjhpc.2017.20.1.26

PURPOSE: To explore the meaning of prayer in Korean patients with end-stage cancer who profess Christianity or Buddhism, given the significant differences between these religions. METHODS: The Colaizzi (1978) analysis method was employed. In-depth interview were performed with 13 participants (seven Christians and six Buddhists) who were admitted to a University-affiliated hospital in Korea. RESULTS: The six categories emerged: 1) communication with God, 2) mind discipline, 3) spiritual growth, 4) mysterious experiences, 5) perception of death and after-life, and 6) various forms of prayers. CONCLUSION: The participants' prayer experiences were described in a religious context. Christians believed that prayer is communication with God while Buddhists regarded it as disciplining of minds. Despite some differences between the religious groups, a general meaning of prayer was a desperate desire to solve their health issues by relying on God or someone who is more powerful than themselves. They also experienced personal and spiritual growth through prayer. This study explains the phenomenon of prayer experiences and shows that prayer is an important coping mechanism.
Buddhism ; Christianity ; Faith Healing ; Humans ; Korea ; Methods ; Religion*

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