Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.
Aged ; Aged, 80 and over ; China ; Female ; Health Expenditures ; Hospitalization ; Humans ; Inpatients ; Male ; Terminally Ill

This descriptive correlational study determined the level of hope and spiritual wellbeing among Filipino caregivers of terminally-ill cancer patients, and the relationship of hope and spiritual wellbeing to various patient and caregiver characteristics. The study involved 50 caregivers of terminally-ill-cancer patients, mostly belonging to 51-60 age group (42%) with mean age of 44 years (SD=15), mostly females (72%), married (62%), Roman Catholic (90%), high school graduates (50%), spouses of patients (28%), with an average of 18.36 hours of caregiving in a day for an average duration of 21.4 months. The hope and spirituality scores of caregivers were 3.24 (SD=0.28) and 3.25 (SD=0.46) respectively. Caregivers had high self-efficacy (3.29) but low social support (1.72). Patient's age was moderately correlated with caregiver's hope (r=0.3; p=0.03). Caregiver's educational attainment was significantly associated with hope (p<0.01) and spiritual wellbeing (p<0.01). Caregiver's self-efficacy was moderately correlated with their spiritual wellbeing (r=0.46, p<0.01). Caregiver's hopes were (1) for their patients to get well and recover from their illness, (2) to have strong spiritual faith and be healed with God's help (3) to be hopeful and positive, (4) hope for longer life, (5) resumption of family relations, and (6) free of pain and other discomforts. Caregivers' thoughts on spiritual wellbeing were to have: (1) stronger faith, (2) being prayerful, and (3) being positive. Compared to other studies, Filipino caregivers had lower hope scores, but higher spiritual wellbeing scores. Nursing interventions promoting hope and spiritual wellbeing should be conducted in patients' room, clinic appointments, or during home visits. Nursing care promoting hope and spiritual wellbeing should be part of patients' activities for daily living.
Humans ; Female ; Adult ; Caregivers ; Spirituality ; Family Relations ; Spouses ; Self Efficacy ; Catholicism ; Patients' ; Rooms ; House Calls ; Terminally Ill ; Hope ; Marriage ; Spiritual Therapies ; Social Support ; Neoplasms ; Pain ; Schools

In terminally ill patients, organ transplantation could be recommended as the treatment of choice. In Korea, living donor liver or kidney transplantation is much more frequent than deceased donor transplantation due to organ shortages from deceased donors. ABO or HLA incompatibility in transplantation can be a major barrier in living donor transplantation. Currently, the rate of ABO incompatible organ transplantation accompanied by desensitization is 20~25% of living donor transplantation, and the blood bank laboratory plays an active role by plasmapheresis. The desensitization of HLA incompatible transplantation in highly sensitized patients is more difficult than that of ABO incompatible transplantation. The HLA antibody is not easy to remove and it is difficult to prevent sensitization. In addition, setting the target treatment goals and predicting the treatment outcomes based on the HLA antibody results are problematic. Therefore, a range of desensitization protocols have been attempted and various therapeutic goals have been introduced. This article reviews the various desensitization methods for antibody removal focusing on HLA incompatible kidney transplantation, and discusses the prognosis of desensitization methods for antibody removal based on the literature.
Blood Banks ; Humans ; Kidney Transplantation ; Korea ; Liver ; Living Donors ; Organ Transplantation ; Plasmapheresis ; Prognosis ; Terminally Ill ; Tissue Donors ; Transplantation ; Transplants

Along with the advances in medical technology and the economic development, more terminally ill patients are receiving hospice and palliative care services. Moreover, hospice and palliative care clinicians have been showing considerable interest in studies that aim to improve the quality of said care for patients and their families. Meanwhile, after the government has strengthened its policy to protect research participants, the institutional review boards (IRBs) are more closely examining various ethical issues related to patients' vulnerability when reviewing protocols for hospice and palliative care research. However, terminally ill patients should be provided with guaranteed qualities of hospice and palliative care to improve and maintain their quality of life. To that end, support should be provided for efforts to conduct ethical and safe studies with hospice and palliative care patients. Thus, this review paper proposes ethical guidelines for hospice and palliative care research. The guidelines could be appropriately used as a reference for researchers who should prepare for ethically safe and scientifically valued research protocols and the IRBs that will review the protocols.
Economic Development ; Ethics ; Ethics Committees, Research ; Hospice Care ; Hospices ; Human Experimentation ; Humans ; Palliative Care ; Patient Rights ; Quality of Life ; 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

BACKGROUND: Terminally ill cancer patients suffer from refractory symptoms, and the last option of treatment is to consider sedatives. However, due to concerns that sedation may shorten survival time, some people prefer not to take sedatives. The purpose of this study was to investigate the effects of sedative administration on survival time among terminally ill cancer patients.METHODS: Two hundreds and thirty-seven patients who were hospitalized to the hospice care unit of public hospitals in Seoul from January, 2015 to March, 2016 were analyzed retrospectively. The univariate and multivariate Cox's proportional hazard regression model was used to determine independent factors related to survival time.RESULTS: The usage of sedation was necessary because the incidence of insomnia was 61.4% in the lorazepam only group, and the incidence of delirium was highest in the haloperidol group and the haloperidol with lorazepam group. Interestingly, multivariate analysis showed that male (HR, 1.766; P < 0.001), decreased consciousness (HR, 1.803; P=0.003), anorexia (HR, 1.506; P=0.012), resting dyspnea (HR, 1.757; P < 0.001), elevated serum bilirubin (HR, 1.657; P=0.001), and the haloperidol with lorazepam group (HR, 0.535, P < 0.001) were each significantly associated with survival time. Furthermore, patients in the haloperidol with lorazepam group survived longer than patients with no such medications.CONCLUSION: There is no evidence that treatment with sedative medication shortens the survival time of patients with terminally ill cancer with refractory symptoms.
Anorexia ; Bilirubin ; Consciousness ; Delirium ; Dyspnea ; Haloperidol ; Hospice Care ; Hospices ; Hospitals, Public ; Humans ; Hypnotics and Sedatives ; Incidence ; Lorazepam ; Male ; Multivariate Analysis ; Palliative Care ; Retrospective Studies ; Seoul ; Sleep Initiation and Maintenance Disorders ; Terminally Ill

Scrapie is a mammalian transmissible spongiform encephalopathy or prion disease that predominantly affects sheep and goats. Scrapie has been shown to overcome the species barrier via experimental infection of other rodents. To confirm the re-transmissibility of the mouse-adapted ME7 scrapie strain to ovine prion protein (PrP) transgenic mice, mice of an ovinized transgenic mouse line carrying the Suffolk sheep PrP gene that contained the A₁₃₆ R₁₅₄ Q₁₇₁/ARQ allele were intracerebrally inoculated with brain homogenates obtained from terminally ill ME7-infected C57BL/6J mice. Herein, we report that the mouse-adapted ME7 scrapie strain was successfully re-transmitted to the transgenic mice expressing ovine PrP. In addition, we observed changes in the incubation period, glycoform profile, and pattern of scrapie PrP (PrP(Sc)) deposition in the affected brains. PrP(Sc) deposition in the hippocampal region of the brain of 2nd-passaged ovine PrP transgenic mice was accompanied by plaque formation. These results reveal that the mouse-adapted ME7 scrapie strain has the capacity to act as a template for the conversion of ovine normal monomeric precursors into a pathogenic form in ovine PrP transgenic mice. The change in glycoform pattern and the deposition of plaques in the hippocampal region of the brain of the 2nd-passaged PrP transgenic mice are most likely cellular PrP species dependent rather than being ME7 scrapie strain encoded.
Alleles ; Animals ; Brain ; Gliosis ; Goats ; Humans ; Mice ; Mice, Transgenic ; Plaque, Amyloid ; Prion Diseases ; PrPSc Proteins ; Rodentia ; Scrapie ; Sheep ; Terminally Ill

PURPOSE: Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. MATERIALS AND METHODS: Patients with terminal cancer, age ≥ 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians' or patients' barriers were also collected. RESULTS: From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians' barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients' denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients' barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). CONCLUSION: One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.
Denial (Psychology) ; Education ; Feasibility Studies ; Hospice Care ; Humans ; Lung ; Male ; Prognosis ; Prospective Studies ; Terminally Ill ; Uncertainty

PURPOSE: This study aimed to identify how an education program on palliative care affects nursing home caregivers' perception of hospice care and attitude towards terminally ill patient care. METHODS: This study was conducted using a nonequivalent control group with a pretest-posttest design. The participants were 101 certified care workers: 58 in the experimental group and 43 in the control. The experimental group completed the palliative care education program consisted of 20 hours of classroom training and 20 hours of clinical practicum. An ANCOVA was performed to compare the score changes to outcome variables. RESULTS: Compared with the control group, the experimental group showed significant pretest-posttest differences in both the perception of hospice care (F=21.09, P < 0.001) and attitude towards caring for terminally ill patients (F=13.28, P < 0.001). CONCLUSION: These results indicate that the palliative care education program for caregivers is effective in preparing participants to provide hospice/palliative care service. Further study is warranted to explore the effects of this program on palliative caregivers' performance.
Attitude to Death ; Caregivers* ; Education* ; Hospice Care ; Hospices* ; Humans ; Nurses' Aides ; Nursing Homes ; Palliative Care* ; Patient Care ; Preceptorship ; Terminally Ill

The demand for hospice services as well as for ‘well-dying’ of terminal patients is increasing as patient financial burden is decreasing due to National Health Insurance coverage for hospice care. Hospice institutions utilize interdisciplinary teams comprising doctors, nurses, dietitians, and other health staffs to provide comprehensive patient management. This report examined the nutritional status of a hospice patient from admission to death as well as the nutrition management of this patient in the hospice ward through nutrition interventions performed by a dietitian in the interdisciplinary team. The patient in the present case was a 74-year-old man diagnosed with pancreatic head cancer who died after 26 days of hospice care following transfer from the general ward. During hospice care, the dietitian monitored the patient's nutritional status and performed 8 nutrition interventions, but his oral intake decreased as the patient's symptoms worsened. The average energy intake rates were 30% and 17% of required rates for oral and artificial nutrition, respectively. In line with a report suggesting that the main focus of nutrition in palliative care should be on improving the quality of life and reducing worry in patients, rather than aggressive nutritional management, there is a need for nutrition interventions that are personalized to individual patients by monitoring progress and offering continuous counseling from the time of admission. In addition, further studies such as comparative analysis of nutritional management in Korean hospice ward will be needed for better nutrition management for terminally ill patients.
Aged ; Counseling ; Energy Intake ; Head and Neck Neoplasms ; Hospice Care ; Hospices* ; Humans ; National Health Programs ; Nutritional Status ; Nutritionists ; Palliative Care ; Patients' Rooms ; Quality of Life ; Terminally Ill