한국 호스피스.완화의료기관 실태 조사

윤영호,최은숙,이인정,이영선,이정석,유창훈,김현숙,백유진,Yun, Young-Ho,Choi, Eun-Sook,Lee, In-Jeong,Rhee, Young-Sun,Lee, Jung-Suk,You, Chang-Hoon,Kim, Hyun-Sook,Paek, Yu-Jin 한국호스피스완화의료학회 2002 한국호스피스.완화의료학회지 Vol.5 No.1

목적 : 연구의 목적은 호스피스 완화의료의 표준화를 위한 기초자료로서 국내 호스피스 완화의료 서비스를 제공하는 의료기관 및 비의료기관의 서비스 대상자, 시설 인력구성, 서비스 내용 및 재정적 문제 등 실태를 파악하는 것이다. 방법 : 설문조사는 2001년 7월부터 10월까지 이루어졌으며, 연구자들이 기존 연구를 참조하여 개발한 총 39항목의 설문지를 반송봉투를 넣어 우편으로 발송하여 조사하였다. 회신이 되었지만 내용을 재확인할 필요가 있는 부분과 회신이 안된 기관은 전화를 통해 설문을 완성하였다. 64개 기관이 설문에 응답하였다. 결과 : 국내에는 호스피스 완화의료 서비스를 제공하는 의료기관이 40개, 비의료기관이 24개 있었다. 의료기관 중 11개 기관은 병원연계 및 독립 또는 별도병동이 었고, 비의료기관 중 6개는 입원이 가능한 독립시설에서 호스피스 완화의료서비스를 제공하고 있었다. 호스피스 완화의료 서비스를 받는 대상자 대부분은 암환자였지만 일부는 말기 질환이 아닌 경우도 포함되어 있었다. 전체 64개 호스피스 완화의료 서비스 기관 중 24개만이 의사, 간호사, 사회복지사 및 성직자가 있었다. 가정호스피스 기관으로서 의뢰체계가 있는 경우는 의료기관 89.7%, 비의료기관 73.7% 였다. 24시간 서비스를 제공하는 기관은 의료기관 65.0%, 비의료기관 37.5%였다. 가족을 위한 휴식공간은 병원중심 호스피스완화의료 프로그램의 50%에서 있었다. 전체 호스피스 완화의료기관의 73.9%는 재정적인 문제가 있었으며, 610%는 정부로부터의 재정적인 지원이 필요하다고 응답하였다. 결론 : 64개 호스피스완화의료 프로그램에서 서비스를 제공하고 있지만 아직도 인력, 서비스의 질 및 시설 측면에서는 문제점이 있었다. 말기환자를 위한 서비스의 질을 향상시키고 의료자원의 효율적인 이용을 촉진하기 위해 호스피스 완화의료 서비스의 표준화와 제도화가 필요하다. Purpose : The purpose of this study was to evaluate the present status of hospice palliative care programs in Korea as a basic database for standardization of hospice palliative care. Method : The data was collected from July to October, 2001. The instrument used for this study was the questionnaires which was consisted of the general characteristics of organization, recipient of service, manpower, contents of service, financial conditions and facilities. Sixty-four hospice palliative care programs answered the questionnaires, confirmed by telephone. Results : They were 40 hospital-based hospice palliative care programs and 24 nonmedical hospice palliative care programs. 11 Hospital-based hospice palliative programs have isolated unit or hospital affiliated free standing hospice. 6 Non-hospital hospice palliative programs have a free standing hospice. Major subjects of hospice palliative program were terminal cancer patients but patients with non-terminal illness were also included. Only 24 of 64 hospice palliative programs had all of the essential professionals : physicians, nurses, social workers, and clergies. Home hospice palliative care programs have a referral system in hospital based (89.7%) and nonmedical programs (73.7%). 24hr hospice are were provided in 26 hospital-based (65.0%) and 9nonmedical programs (37.5%). There were rooms for family in half of hospital-based programs. 73.9% of hospice palliative care programs have financial problems. 62.0% of Hospice palliative care programs need financial support from government. Conclusion : 64 Hospice palliative care programs provided hospice palliative services but had many problems in manpower, quality of care and facility. For improving the quality of terminal patients' life and promoting the cost effectiveness of health care resources, it is necessary to consider the standardization and institutionalization of hospice palliative care.

Terminal cancer patients’ and their primary caregivers’ attitudes toward hospice/palliative care and their effects on actual utilization: A prospective cohort study

An, Ah Reum,Lee, June-Koo,Yun, Young Ho,Heo, Dae Seog SAGE Publications 2014 Palliative medicine Vol.28 No.7

<P><B>Background:</B></P><P>Previous studies on hospice/palliative care indicated that patients’ socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated.</P><P><B>Aim:</B></P><P>To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities.</P><P><B>Design:</B></P><P>A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient’s death, caregivers were interviewed whether they utilized hospice/palliative care facilities.</P><P><B>Participants:</B></P><P>A total of 359 patient–caregiver dyads completed baseline questionnaires. After the patients’ death, 257 caregivers were interviewed.</P><P><B>Results:</B></P><P>At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16–3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20–3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver’s preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53–4.67). No patient-related factors were associated with hospice/palliative care utilization.</P><P><B>Conclusion:</B></P><P>Promoting awareness of prognosis and to improve communication between doctors and families is important for facilitating the use of hospice/palliative care.</P>

호스피스・완화의료 환경에서 작업치료사의 역할과 인식 및 지식에 대한 조사 연구

정선아,홍덕기,이충진 대한지역사회작업치료학회 2021 대한지역사회작업치료학회지 Vol.11 No.2

목적 : 본 연구는 호스피스·완화의료 환경에서 작업치료사의 역할과 인식 및 지식을 확인하고 호스피스·완화의료 작업 치료에 대한 기초자료를 수립하고자 하였다. 연구방법 : 본 연구는 연구 참여에 동의한 전국의 작업치료사 200명을 대상으로 하였다. 온라인 설문지를 통하여 설문 조사를 실시하였으며, 설문 문항은 총 41문항으로 일반적 특성 6문항, 호스피스·완화의료 작업치료사 역할 관련 10 문항, 호스피스·완화의료 지식측정 20문항, 호스피스·완화의료 작업치료에 대한 인식 5문항으로 구성되었다. 일반적 특성과 호스피스·완화의료 환경에서의 작업치료사의 역할에 대해 기술통계를 사용하였으며, 일반적 특성에 따른 호 스피스·완화의료 지식측정의 차이를 파악하기 위해 Mann-Whitney 검정과 Kruskal-Wallis 검정을 실시하였다. 그 리고 호스피스·완화의료에 대한 인식이 호스피스·완화의료 지식에 미치는 영향을 확인하기 위해 다중회귀분석을 실시하였다. 결과 : 호스피스·완화의료 작업치료사의 역할에 대한 우선순위는 죽음에 대한 준비, 통증 예방과 감소, 삶의 질 순서로 높았다. 호스피스·완화의료에 대한 전반적인 인식에 대해서는 낮았고 호스피스·완화의료 작업치료와 교육과정에 대 한 필요성은 높았다. 연구 대상자들의 일반적 특성에 따른 호스피스·완화의료 지식에 대한 비교분석에서 유의한 차 이를 보이지 않았다(p>.05). 또한 호스피스·완화의료에 대한 인식이 지식에 미치는 영향은 나타나지 않았다(p>.05). 결론 : 국내 작업치료사들의 호스피스·완화의료 작업치료에 대한 견해 및 수준을 확인할 수 있었다. 향후에는 호스피스· 완화의료 작업치료에 대한 교육과정 개발 및 관련 연구가 진행될 필요가 있다. Objective : In this study, we tried to establish the basic data of occupational therapy in hospice and palliative care by confirming the role, awareness and knowledge of occupational therapists in the environment of hospice and palliative care. Methods : This study was conducted with 200 occupational therapists from all over the country who agreed to participate in the study. The survey was conducted through an online questionnaire. The questionnaire consisted of a total of 41 questions, including 6 general characteristics, 10 questions related to the role of occupational therapist in hospice·palliative care, 20 questions on knowledge measurement of hospice·palliative care, and 5 questions on perception of occupational therapy in hospice·palliative care . Descriptive statistics were used for the general characteristics and priority, frequency, and proportion of occupational therapy roles in hospice and palliative care. Independent sample T-test and Kruskal-Wallis test were performed to understand the difference in hospice and palliative care knowledge measurement according to general characteristics. Multiple regression analysis was conducted to confirm the effect of perception of hospice and palliative care on knowledge of hospice and palliative care. Results : The priority for the role of occupational therapists in hospice and palliative care was high in the order of prepare for death, pain prevention and reduction, and quality of life. Overall awareness of hospice and palliative care was low, and the need and curriculum for occupational therapy in hospice and palliative care were high. Comparative analysis of hospice and palliative care knowledge according to general characteristics of occupational therapists did not show any significant difference. Conclusion : Through this study, it was possible to confirm the opinion and level of occupational therapy in hospice and palliative care of domestic occupational therapists. In the future, it is necessary to develop a curriculum for hospice and palliative care occupational therapy and to conduct related research.

자문형호스피스 시범사업 성과평가 및 건강보험 적용방안 연구

박영택,오주연,신양준,이다희 건강보험심사평가원 심사평가연구소 2020 연구보고서 Vol.2020 No.0

배경: 보건복지부는 2017년 8월 14일부터 말기환자를 대상으로 일반병동에서 호스피스서비스를 제공하는 “자문형호스피스” 시범사업을 시작하였다. 자문형호스피스는 일반병동에서 서비스를 제공하는 것으로, 독립적 병동에서 호스피스 서비스를 제공하는 “입원형호스피스”와 차이가 있다. 그 동안 이 시범사업을 평가한 어떠한 연구도 없었다. 목적: 본 연구의 목적은 자문형호스피스 시범사업을 평가하고, 건강보험시스템 적용을 위한 적용방안을 제시하는 것에 있다. 결과: 2019년 12월 31일 현재 27개 병원이 시범사업에 참여하고 있다. 2년 반 동안 총 7,910명의 환자가 자문형호스피스를 이용하였다. 시범사업을 구조, 과정, 결과적 관점에서 평가하였다. 구조적 관점에서, 시범사업기관은 지역적 불균형이 있었지만, 인력기준, 관리체계, 교육체계, 수가 등은 평균이상의 적정성을 유지하고 있었다. 과정측면에서, 2019년도의 평균입원일수는 19.1일 이었으며, 의료기관종별, 의료보장 유형별 재원일수의 차이는 없었다. 호스피스서비스 이용을 위한 대기시간은 자문형이 입원형에 비하여 짧았다. 반면 초기상담 후 등록거부율은 47.8%로 높았다. 자문형호스피스 서비스의 제공은 원활하였으나, 환자의 병동 주치의와 자문형주치의간 의사소통에 어려움이 있는 것이 관찰되었다. 암환자 이외의 환자비율은 1.5% 수준으로 낮았다. 자문형과 입원형 환자 중 생애 첫 호스피스를 이용하는 자문형호스피스 환자의 비율(입원과 외래)은 약 25.2%이었다. 결과측면에서, 환자당 총진료비와 환자1일당 진료비는 각각 약 900만원과 45만원이었다. 사망1~6개월의 입원진료비는 자문형이 입원형보다 높았지만, 암환자보다는 낮았다. 사망1~6개월의 모든 진료비는 자문형이 입원형과 암환자보다 낮았다. 자문형호스피스 프로그램은 환자가 호스피스를 조기진입하도록 하는 것에 효과가 있었다. 자문형호스피스 입원환자의 입원 후 7일 이후 통증정도는 크게 낮아졌다. 그러나 자문형호스피스 환자가족 및 국민의 자문형호스피스서비스에 대한 만족도는 입원형에 비하여 상대적으로 낮았다. 자문형호스피스의 효율적 건강보험적용방안과 관련하여 다음과 같은 정책대안이 필요하다. 첫째, 정부는 지역적 불균형을 없애기 위하여 자문형호스피스 제공기관을 늘려야 한다. 둘째, 완화의료와 자문형호스피스를 포함한 호스피스 돌봄이 잘 연계될 수 있도록 하는 의료전달체계를 만드는 것이 필요하다. 셋째, 정부는 자문형호스피스서비스의 질을 평가하는 프로그램을 도입하는 것이 필요하며, 질 평가 결과에 따른 수가적인 인센티브를 주도록 한다. 질 평가는 환자와 그 가족의 경험평가를 주로 반영하도록 하며, 부가적으로 호스피스서비스 제공의 구조와 과정 평가결과를 고려토록 한다. 넷째, 정부는 2~3개의 수가항목을 신설 또는 기존 수가를 조정하도록 한다. 대표적인 예로, 사전상담료의 신설과 임종실료의 수가를 현실화(인상)하는 것 등이 있다. 마지막으로 자문형호스피스 돌봄 지침 표준화, 호스피스 데이터 공유 및 서비스질 개선을 위한 사용, 정책지원에 대한 거버넌스의 개발 등이 필요하다. 토론: 자문형호스피스 시범사업은 비용이 다소 높을 뿐 구조, 과정, 결과적 측면에서 성공적인 성과를 거두는 것을 볼 수 있었다. 시범사업에서 나타난 문제점들은 완화의료와 호스피스의 통합, 일반급성기 병동에서 호스피스를 제공하는 현재의 모델에서 오는 것으로 예측되었다. 정부는 호스피스와 완화의료가 각각 독립 및 상호 발전시켜 나아갈 수 있는 정책을 마련할 필요가 있다. 이러한 방향으로 정부가 정책을 만든다면 말기환자를 위한 호스피스와 완화의료서비스의 질은 크게 향상될 것이다. Background: On August 14, 2017, the Ministry of Health and Welfare (MOHW) of South Korea implemented the Consultative Hospice Care (COHC) for terminally ill patients in the acute-care wards. COHC is different from the hospice care provided in the Independent Hospice Unit (IHU) in that COHC was offered to those in acute-care wards. There has been no study that evaluated this pilot project. Objective: To evaluate the COHC project and to review application potential and method of the national health insurance system (NHIS). Results: There were 27 hospitals participating in the project as of December 31, 2019. A total of 7,910 patients received COHC for 2.5 years. This study evaluated the project in the standpoints of structure, process, and results. As for structure, although accessibility to COHC varied upon regions, the level of appropriateness on staffing, governance, training system, and fee schedule showed above the average. Regarding process, average length of stay of COHC patients was 19.1 days which did not differ by type of hospitals nor type of insurance status (NHIS or Medical Aid). Waiting time for COHC was shorter than those of IHU. Denial rate of registrating COHC after initial consultation was 47.8%. Although the delivery of COHC was well processed, some communication difficulties were observed between attending physicians of acute-care unit and those in COHC program. Percent of non-cancer patients was as low as 1.5%. Among COHC and IHU patients who used hospice care for the first time during their entire life, COHC inpatients took up 21.3% of all patients. For result perspective, total healthcare expenditure (HE) and daily health expenditure of COHC per patient were approximately KRW 9 million and KRW 450,000 respectively. Inpatient HE of COHC per patient before 6-month death was higher than those of IHU, but lower than that of cancer patients. Both total and daily expenditure of COHC per patient were much lower than IHU and cancer patients. The COHC program was effective on early entry of terminally ill patients to a hospice program. Patient pain level significantly decreased after 7th day from admission to COHC. However, satisfaction level was relatively low among patient’s family and general public using COHC program compared to that of IHU. There are a set of prerequisite to cover COHC under NHIS efficiently. First, the government should increase the number of COHC providers to reduce accessibility imbalance by region. Second, current healthcare delivery system needs to improve connectivity to palliative medical care and hospice care including COHC. Third, the government should introduce evaluation program to COHC and provide financial incentives to high-performing hospice providers upon the result. The quality assessment should reflect experience of patients and their family as the main input, and additional evaluation item should include the structure, process, and outcome of hospice service. Fourth, the government should add a few new items to the fee schedule and/or adjust existing fees. To name a few, pre-consultative service fee can be newly introduced, and rate on the use of bereavement room in hospitals should be increased. Last but not least, other necessary items include standardization of COHC practice guideline, sharing and utilization of hospice data for quality improvement, and development of governance for policy support. Discussion: Although the HE of COHC was higher than those of IHU, overall performance level of COHC project was successful in structure, process, and outcome. Observed issues were predicted given the integration of palliative care and hospice care, and delivery of hospice services in acute-care setting. Thus, the government needs to prepare policies to allow hospice and palliative care to develop independently, yet in a mutually beneficial way, so that the quality of care can improve significantly in both hospice and palliative care.

아동간호사의 호스피스 · 완화의료에 대한 지식, 인식과 임종간호 스트레스

박은영 ( Park Eunyoung ),방경숙 ( Bang Kyung-sook ) 서울대학교 간호과학연구소 2019 간호학의 지평 Vol.16 No.2

Purpose: This study examined the knowledge and perception of hospice-palliative care and terminal care stress among pediatric nurses, and the relationships among these variables. Methods: In this descriptive research study, 154 pediatric nurses who experienced terminal care at least once were surveyed. This study used three scales, including the Palliative Care Quiz for Nursing (PCQN), Perception of Hospice-Palliative Care, and Terminal care stress. Data analyses using SPSS 22.0 included descriptive statistics, independent t-test, one-way ANOVA, Mann-Whitney U test, Pearson’s correlation coefficient, and stepwise multiple linear regression. Results: Terminal care stress experienced by the pediatric nurses was significantly related to the perception of hospicepalliative care; the hospice-palliative care education program enhanced the knowledge and perception of hospicepalliative care. Conclusion: Hospice-palliative care education programs should be developed and provided for pediatric nurses to improve pediatric hospice-palliative care. Additionally, further research on this topic is required because the present results are inconsistent with previous and current researches.

End-of-Life and Hospice Issues in Korean Aging Society

Yi-Jong Suh 서울대학교 사회발전연구소 2016 Journal of Asian Sociology Vol.45 No.2

This paper deals with legal and institutional aspects of end-of-life and hospice issues in Korea. With the high speed of aging in Korean society we face end-of-life issues and policies at the terminal stage. Policies on life-sustaining treatment decisions to death in later life were developed from the 2000’s and legislated into the Cancer Control Act in 2010. It was not until February 2016 that the Cancer Control Act was a legal provision of hospice and palliative care even for terminal cancer patients. The Cancer Control Act made an impact on the institutional and financial situations of hospice and palliative care. The first impact is a medical care-centered care flow and a transfer model for hospice and palliative care. Public policies focus on hospice services inside general hospitals, so that independent hospice centers or community services are underdeveloped. The second impact is a patient-initiated decision model into hospice and palliative care. Physicians had no legal obligation to explain to patients their terminal situation and prognosis and could inform them only when they choose Therefore, it was not until July 2015 that hospice and palliative care was covered by the public health insurance system.

호스피스·완화의료 자원봉사자 교육 프로그램 활성화 방안

조현 ( Hyun Cho ),조병모 ( Byungmo Cho ),조서영 ( Seo Young Cho ),조슬민 ( Seul Min Cho ),정성훈 ( Sung Hoon Jeong ) 대한보건협회 2021 대한보건연구 Vol.47 No.1

연구목적 : 본 연구는 호스피스 · 완화의료 다학제팀의 일원으로 활동하고 있는 자원봉사자 등 비전문 인력이 양질의 호스피스 · 완화의료 돌봄을 제공할 수 있는 교육 프로그램 개발하는 것을 목적으로 한다. 연구방법 : 문헌 연구를 통해 국내외에서 진행되고 있는 호스피스 · 완화의료 교육 프로그램과 사례 점검 1) 관련 통계를 이용하여 호스피스 · 완화의료 현황을 파악 2) 문헌 고찰을 통해 국내외 호스피스 · 완화의료 교육 프로그램 분석 3) 분석된 교육 프로그램을 기반으로 자원봉사자 교육 프로그램 개발 연구결과 : 호스피스 · 완화의료 자원봉사자 교육 프로그램으로 이론 강의 및 시청각 자료를 통하여 ‘호스피스 · 완화의료 개요’, ‘삶과 죽음’, ‘호스피스 · 완화의료 돌봄’, ‘말기질환(암) 이해’, ‘통증관리’, ‘의사소통’, ‘스트레스 관리’, ‘연명의료결정법’, ‘뇌사’, ‘장기이식’, ‘사별가족 돌봄’ 등을 교육 후 현장 실습을 통한 사례관리 결론 : 표준화된 호스피스 · 완화의료 자원봉사자 교육 프로그램의 개발과 온라인 교육 확대가 필요하며 교육 이수 후 수료증 교부 및 일자리 창출이 가능한 자격증 발급 등을 통해 자원봉사자 육성을 준비 Objectives : As part of a multidisciplinary team of hospice·palliative care, this study aims to develop an education program which provides hospice·palliative care of superior quality for nonprofessional labor force including volunteers. Methods : Through literature review, this study inspects hospice·palliative care education programs and cases which are taking place in and out of Korea 1) Grasp the current hospice·palliative care conditions through statistics 2) Analyze hospice·palliative care education programs through literature review 3) Develop a new model of education program for volunteers based on analyzed education programs Results : Focusing on hospice·palliative care education program which incorporates basic lecture and audiovisual materials, the study will manage post-education placement cases with regard to ‘hospice·palliative profile’, ‘life and death’, ‘hospice·palliative care’, ‘understanding of terminal illness(cancer)’, ‘pain management’, ‘‘communication’, ‘stress management’, ‘Act on Life Prolongation Decision-making’, ‘brain death’, ‘organ transplant’, ‘bereavement care’, and others. Conclusion : Development of a standardized education program for hospice·palliative care volunteers as well as expanded education in online setting are required. It is also necessary to foster volunteers by issuing certificates upon completing education for potential employment opportunities.

Spiritual Care Guide in HospiceㆍPalliative Care

Kyung-Ah Kang,Do-Bong Kim,Su-Jin Koh,Myung-Hee Park,Hye Yoon Park,Deuk Hyoung Yoon,Soo-Jin Yoon,Su-Jeong Lee,JI-Eun Choi,Hyoung-Suk Han,Jiyoung Chun 한국호스피스완화의료학회 2023 한국호스피스.완화의료학회지 Vol.26 No.4

The Spiritual Care Guide in HospiceㆍPalliative Care is evidence-based and focuses on the universal and integral aspects of human spirituality—such as meaning and purpose, interconnectedness, and transcendence—which go beyond any specific religion. This guide was crafted to improve the spiritual well-being of adult patients aged 19 and older, as well as their families, who are receiving end-of-life care. The provision of spiritual care in hospice and palliative settings aims to assist patients and their families in finding life’s meaning and purpose, restoring love and relationships, and helping them come to terms with death while maintaining hope. It is recommended that spiritual needs and the interventions provided are periodically reassessed and evaluated, with the findings recorded. Additionally, hospice and palliative care teams are encouraged to pursue ongoing education and training in spiritual care. Although challenges exist in universally applying this guide across all hospice and palliative care organizations in Korea—due to varying resources and the specific environments of medical institutions—it is significant that the Korean Society for Hospice and Palliative Care has introduced a spiritual care guide poised to enhance the spiritual well-being and quality of care for hospice and palliative care patients.

중환자 간호사의 호스피스,완화의료에 대한 태도와 이에 영향을 미치는 요인

설은미 ( Eun Mi Seol ),고진강 ( Chin Kang Koh ) 서울대학교 간호과학연구소 2015 간호학의 지평 Vol.12 No.2

Purpose: The study purpose was to describe critical care nurses’ attitudes toward hospice and palliative care and their related factors. Methods: In this cross-sectional descriptive study, 175 critical care nurses who worked at a general hospital in Seoul participated via self-report survey. The Frommelt Attitude Toward Care of the Dying Scale was used to measure their attitudes, and a palliative care quiz for nursing was used to measure their knowledge about hospice and palliative care. Results: Education level, duration of nursing employment, duration of critical care nursing employment, and knowledge about hospice and palliative care were significantly associated with nurses’ attitudes. In the multiple regression analysis, education level, and duration of nursing employment were significant predictors of nurses’ attitudes. Conclusion: These findings suggest that education programs to improve nurses’ knowledge about hospice and palliative care should be developed. These will help critical care nurses obtain a positive attitude toward hospice and palliative care.

전이성 뇌암 환자의 호스피스 완화의료

문도호,최화숙,Moon, Do-Ho,Choe, Wha-Sook 한국호스피스완화의료학회 2005 한국호스피스.완화의료학회지 Vol.8 No.1

목적: 치료에 관계없이 뇌전이는 예후가 불량하다. 본 연구는 뇌 전이로 호스피스 완화의료를 받았던 환자를 대상으로 적절한 돌봄을 받았는지를 알아보고 임상적인 특성을 알아보고자 하였다. 방법: 2003년 3월부터 2005년 3월까지 본원의 호스피스 병동에서 뇌전이로 호스피스 완화의료를 받았던 40명의 말기 암환자를 대상으로 후향적으로 의무기록을 조사하였다. 결과: 대상자 중 남자 20명(50%), 여자 20명(50%)이며 연령의 중간값은 64세 였다. 가장 많은 암은 폐암으로 22명(55%)이고 다음으로 위암 5명(13%), 유방암 3명(8%) 순서였다. 원발암에 대한 전치료는 전혀 치료를 하지 않은 환자가 16명(40%)이고 항암치료는 20명(50%)를 받았다. 뇌전이 때의 증상은 두통 12명(30%), 의식변화 10명(25%), 국소 약화 9명(23%), 경련 4명(10%) 순서였다. 호스피스 병동의 입원 이유는 의식변화가 13명(33%)으로 가장 많았고 통증이 9명(23%)였다. 호스피스 완화의료를 받게 된 이유로 환자와 가족이 원한 경우가 14명(35%), 의사가 의뢰한 경우가 1명, 그 나머지 25명(62%)은 본원에서 보존적인 요법을 받던 중 호스피스 완화의료를 받게 된 경우이다. 호스피스 병동에서 입원기간의 중간값은 19일이었으며 호스피스 완화의료로 전원 후 생존기간의 중간값은 41일이었다. 뇌전이 진단 후 중간 생존기간은 87일이었다. 결론: 전이성 뇌암 환자의 호스피스 완화의료의 기간은 환자를 돌보기에는 충분하지 못하였다. 효과적인 호스피스 완화의료를 위해서는 의사와 환자, 가족에 대한 지속적인 호스피스 완화의료 교육과 홍보가 필요하리라고 생각된다. Purpose: Regardless of treatment, brain metastases are associated with a poor prognosis. We aimed to investigate the clinical characteristics of cancer patients with brain mestastases they after admission into a hospice unit and knowing they have received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 40 cancer patients with brain metastases they after admission into a hospice unit from March in 2003 to March in 2005. Results: There were 20 males (50%) and 20 females (50%), and the median age of the patients was 64 years. The most common cause of brain metastases was lung cancer (22 patients, 55%), followed by stomach cancer (5, 13%) and breast cancer (3, 8%). Sixteen patients (40%) have never been teated and 20 patient have received the chemotherapy for the primary cancer. The most common symptom of cancer patients with brain metastases is headache (12 patients, 30%), followed by mental change (10, 25%), focal weakness (9, 23%) and convulsion (4, 10%). The most prevalent cause for admission was mental change (13 patients, 33%), followed by pain (9 patients, 23%). The reasons for hospice and palliative care were through recommendation of physician (1 patient, 3%), patient and family self (14, 35%) and the others (25, 62%). Twenty five of the others has been referred to hospice and palliative care during conservative management after referral and enrolled at hospice unit. The median hospitalization was 19 days and median survival in hospice and palliative care was 41 days. The median survival was 87 days from the day when the cancer patients have been diagnosed as brain metastases to death. Conclusion: The duration of hospice and palliative care was not enough to care the cancer patients with brain metastases. We suggest physicians, patients and family need the education and promotion for effective hospice and palliative care.