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>

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.

Comparison of the Attitudes of Nurses and Physicians toward Palliative Care in Neonatal Intensive Care Units

Jung, Ha Na,Ju, Hyeon Ok Korean Society for Hospice and Palliative Care 2021 한국호스피스.완화의료학회지 Vol.24 No.3

Purpose: This study aimed to compare the attitudes of nurses and physicians toward neonatal palliative care and identify the barriers to and facilitators of neonatal palliative care, with the goal of improving palliative care for infants in neonatal intensive care units (NICUs). Methods: This cross-sectional study analyzed data from the NICUs of seven general hospitals with 112 nurses and 52 physicians participating. Data were collected using the Neonatal Palliative Care Attitude Scale questionnaire. Results: Only 12.5% of nurses and 11.5% of physicians reported that they had sufficient education in neonatal palliative care. In contrast, 89.3% of the nurses and 84.6% of the physicians reported that they needed further education. The common facilitators for both nurses and physicians were: 1) agreement by all members of the department regarding the provision of palliative care and 2) informing parents about palliative care options. The common barriers for both nurses and physicians were: 1) policies or guidelines supporting palliative care were not available, 2) counseling was not available, 3) technological imperatives, and 4) parental demands for continuing life support. Insufficient resources, staff, and time were also identified as barriers for nurses, whereas these were not identified as barriers for physicians. Conclusion: It is necessary to develop hospital or national guidelines and educational programs on neonatal palliative care, and it is equally necessary to spread social awareness of the importance of neonatal palliative care.

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.

Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan

Hamdan Khaldoun Mohammad,Al-Bashaireh Ahmad M.,Al-Dalahmeh Mohammad,Saifan Ahmad Rajeh,Albqoor Maha Alkaid,Shaheen Abeer M. 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.4

Background: There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study’s purpose was to examine nurses’ knowledge and attitudes toward palliative care.Methods: A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data.Results: We measured nurses’ knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type.Conclusions: ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.

Barriers to Effective Communication about Advance Care Planning and Palliative Care: A Qualitative Study

Hyosin Kim,Signe Peterson Flieger Korean Society for Hospice and Palliative Care 2023 한국호스피스.완화의료학회지 Vol.26 No.2

Purpose: The purpose of this study was to identify barriers to effective conversations about advance care planning (ACP) and palliative care reported by health care and community-based service providers in Massachusetts, USA. Methods: This qualitative research analyzed open-ended responses to two survey questions, inquiring about perceived barriers to having conversations about ACP and palliative care with patients and consumers. Data were collected between November 2017 and June 2019 from nine organizations in Massachusetts, including health care provider organizations, health insurers, community-based organizations, and a nursing education institution. Two researchers reviewed and coded the responses and identified common themes inductively. Results: Across 142 responses, primary barriers to ACP included hesitation and lack of understanding and knowledge, discomfort and resistance among service providers, lack of staff knowledge, difficulties with followup, and differences in ACP policies across regions. Common barriers to palliative care were misconceptions about palliative care and lack of knowledge, service providers' lack of preparedness, and limited policy support and availability. Challenges relevant to both ACP and palliative care were fear and discomfort around serious illness discussions, lack of knowledge and awareness, discussions that occur too late, and cultural and language barriers. Conclusion: Health care practitioners and community-based professionals reported consumer-, service provider-, and system-level barriers to facilitating conversations about ACP and palliative care with patients experiencing serious illness. There is a need for more tools and support to strengthen service providers' ACP and palliative care competencies and to promote a structured approach to health care planning conversations.

Evaluation of Outcomes of the Busan Community-based Palliative Care Project in Korea

최순옥,김숙남,Seong-Hoon Shin,류지선,백정원,김정림,김내현 한국간호과학회 2018 Asian Nursing Research Vol.12 No.4

Purpose: This study aimed to evaluate the outcomes of a community-based palliative care project conducted in Busan city, Korea, from 2013 to 2015. Methods: We selected four outcome indices based on the project's outcomes derived from a logic model and used a longitudinal and cross-sectional comparative design approach depending on the outcome index. Results: The utilization rate of palliative care increased from 9.2% in 2012 to 41.9% in 2015. Regarding symptom changes in 65 patients receiving palliative care at 3 and 6 months (mean age = 72 years, standard deviation = 9.64, 55.4% women), pain, anxiety, and depression had improved. Quality of life was higher among palliative care patients compared with patients who did not receive palliative care (t = 2.09, p = .039). Regarding recognition of palliative care, civil servants at public health centers who participated in the pilot project (2013-2014) scored higher than those at public health centers who began participation in 2015 (t = 2.67, p = .008). Conclusion: This is the first study in Korea that systematically evaluated community-based palliative care. The Busan Community-based Palliative Care Project improved the quality of life of palliative care patients by providing services at an appropriate level and by raising the recognition of palliative care in the community. To increase the utilization ratio of palliative care and the quality of service, strategies should be developed to supplement medical support systems.

Development of an Early Palliative Care Intervention Based on Person-Centered Care in Intensive Care Units

Hye Young Yun,Sanghee Kim,Euiguem Oh,Yeonsoo Jang,Phill Ja Kim,Im Kyoung Kim 한국성인간호학회 2021 성인간호학회 학술대회 Vol.2021 No.8

Aim(s): Clinical indicators tend to be emphasized among critically ill patients, for whom the maintenance of vital functions is important, while their dignity as human beings tends to be downplayed. However, pain relief and respect for critically ill patients improve the clinical outcomes and experience. Therefore, a need exists for interventions that guarantee the safety and dignity of critically ill patients and provide individual critical care with caregiver participation. The purpose of this study was to develop an early palliative care intervention based on person-centered care in an intensive care unit (ICU). Method(s): This methodological study was designed to develop early palliative care interventions. Based on the person-centered care theory, a draft intervention was developed by identifying 7 cases of interventions in foreign institutions that provide palliative care in ICUs and conducting a systematic, integrated literature review of palliative care interventions and person-centered care interventions in ICUs. We then conducted individual interviews with 5 health-care providers and 5 caregivers of critically ill patients. Next, we developed a draft protocol for an early palliative care intervention based on person-centered care in ICUs, which 6 experts in intensive and palliative care evaluated for content validity. Finally, a revised version of the early palliative care intervention for patients in ICUs was established. Result(s): Our early palliative care intervention based on person-centered care in ICUs includes working with the patient’s beliefs and values, engaging authentically, sharing decision-making, being sympathetically present, and providing holistic care. It consists of interventions to be performed within 1 day after admission to the ICU, interventions to be performed within 3 days, and interventions that should be performed daily. In addition, the multidisciplinary team provided interventions. The scale-level content validity index of the draft intervention for early palliative care based on person-centered care in the ICU was 0.88, which was judged as representing a consensus among the experts. Conclusion(s): We developed an early palliative care intervention based on person-centered care in ICUs. It is a planned and systematic intervention that is provided within 3 days of a patient entering the ICU and is delivered by health-care providers in ICUs. This intervention would be helpful for providing a positive experience for critically ill patients and their caregivers within the philosophy of patient-centered care.

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

Shu-Wan Chiang,Shu-Chen Wu,Tai-Chu Peng 한국간호과학회 2021 Asian Nursing Research Vol.15 No.1

Purpose: The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities. Methods: Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews. Results: Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as “the guardians at the end of life” reflects the spirit of palliative care. Conclusion: This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

Palliative care for those with heart failure: Nurses’ knowledge, attitude, and preparedness to practice

Kim, Sanghee,Hwang, Won Ju SAGE Publications 2014 European journal of cardiovascular nursing Vol.13 No.2

<P><B>Background:</B></P><P>Palliative care is an important element of holistic care but has received little attention in cardiac disease patients. The purpose of the paper is (a) to investigate nurses’ knowledge of palliative care, attitudes toward care of the dying, coping with death, and preparedness to practice palliative care for those with heart failure, and (b) to evaluate influencing factors on preparedness to practice on palliative care.</P><P><B>Methods:</B></P><P>A cross-sectional descriptive design employed a structured questionnaire that tested nurses’ knowledge, attitude, coping, and preparedness to practice on palliative care for patients with heart failure. Ninety nurses in two tertiary university hospitals in South Korea participated in the survey. Data were analyzed with descriptive statistics, correlation, and multiple regression.</P><P><B>Results:</B></P><P>Results showed low levels of knowledge reported (an average of 48.3% correct answers), attitude (134.8±110.1), coping (117.2±24.3), and preparedness to practice (17.3±4.7) relating to palliative care. The extent of knowledge was related to both attitudes and coping. These attitudes and coping skills were related to preparedness to practice. The multiple regression analysis showed that preparedness to practice was explained by coping and attitude (<I>R</I> <SUP>2</SUP> =0.46, <I>F</I>=6.1, <I>p</I><0.001).</P><P><B>Conclusions:</B></P><P>Palliative care training is urgently needed to improve knowledge, attitude, coping, and preparedness to practice. Guidance to assist healthcare professionals involved in palliative care for those with cardiac disease needs to be developed and provided.</P>