말기 암환자와 가족을 위한 집단상담 프로그램 - 서울대학교병원 경험의 분석-

이영숙,허대석,윤영호,김현숙,최경숙,윤여정,Lee, Young-Sook,Heo, Dae-Seog,Yun, Young-Ho,Kim, Hyun-Sook,Choi, Kyung-Sook,Yun, Yeo-Jung 한국호스피스완화의료학회 1998 한국호스피스.완화의료학회지 Vol.1 No.1

목적 : 본 연구는 서울대학교병원의 말기암환자와 가족을 위한 집단상담 프로그램을 소개하고, 현황 및 문제점을 파악하고자 하였다. 방법 : 1996년 한 해동안 상담에 참석한 말기암환자 및 가족들의 상담기록지를 중심으로 연구자들이 상담한 내용을 분석하였다. 결과 : 참석자 312명은 가족(84%)이 환자(16%)의 4배 이상 참석했고, 대부분 1회만 참석하고 있음을 보여주었다. 참석한 환자 또는 가족이 돌보는 환자의 현황은 나이별로 60대, 50대, 40대가 많았고, 암의 종류는 폐암, 위암, 간암 순으로 많았다. 가족의 특성은 261명으로 배우자, 자녀, 며느리, 형제자매, 부모순으로 많았다. 프로그램에 오게된 경로는 의사의 권유(69%), 병원 포스터(26%), 기타 순이었다. 이것은 의사가 환자와 가족을 집단에 참여시키는데 중요한 역할을 담당하고 있음을 보여준다. 질문은 우선적으로 의료적인 정보에 대한 욕구가 많았다. 이것은 환자나 가족이 의료진으로부터 정보를 제대로 전달받지 못하고 있음을 보여준다. 또한 가족은 환자를 돌보는데 있어서 정보의 제공만으로 해결될 수 없는 여러가지 실제적인 어려움을 주고 있었다. 그 결과 계속적인 24시간 전화상담 서비스 호스피스 시설 가정간호 서비스의 확대, 3차 의료기관과 1,2차 의료기관과의 의뢰 체계 등을 필요로하고 있었다. 따라서 병원에서 제공될 수 있는 프로그램과 지역사회에서 제공될 수 있는 자원, 호스피스 시설과의 연계가 필요하며 이를 관리해줄 수 있는 환자 관리 전담 인력이 필요하다. 결론 : 본 프로그램은 1회(single-session)적인 성격이 강하지만 환자와 가족이 궁금해하는 점들을 만족시켜주므로서 암에 대한 인식이 증가하고 대처능력이 향상되고 있음을 볼 수 있다. 이것은 이 프로그램이 위기에 처한 말기암환자와 가족을 지지하는 프로그램으로서 활용가치가 높다고 볼 수 있다. 추후 연구는 프로그램의 효용성에 대한 평가가 검토되어야 할 것이며, 다른 병원에서도 각 병원의 특성과 참석자들의 특성을 고려하여 보다 발전된 프로그램이 나오기를 바란다. Purpose : Seoul National University Hospital developed a group counseling program for the terminal cancer patients and their family members. This program consists of each of doctor, nutritionist, nurse, pharmacist, and social worker to provide them with the information and to enhance their ability to cope with terminal cancer. This research aims to introduce this new program per se, and to appreciate its validity and applicability to the terminal cancer patients and their family members by analyzing the concerns and specific questions of the participants. Methods : The methodological approach employed in this research is 1996 content analysis of the group counseling reports, and interview of the 312 participants. The analysis includes the general characteristics of the subjects, family relationship to the patients, times of attendance to the group session, source of information to the program. Results : The participants consist of 261 family members(84%) and 51 patients(16%). Majority responded to the program with a single-attendance. Diagnosis are mainly lung cancer, stomach cancer, liver cancer. The ratio of participants by family members is decreased in the order of spouse, children, daughter-in-law, brothers and sisters, and parents. The source of information to the program is largely through medical staff(69%) as compared with posters in the hospital (26%). The participants are interested primarily in the medical information. Their interests are various, such as pain control, patient care, nutrition, psychosocial problem and etc. Conclusion : This program is characterized largely as a family-supporting program which primarily offers information for terminal cancer. This program is a sort of a hospice program, which maximizes the present quality of living of the terminal cancer patients as long as life continues by encouraging them to live with terminal cancer. Thus, this group program can be employed as an active support network for the patients and their family. In order to develop comprehensive care-giving services, it is required to have 24-hour telephone service, hospice facilities, home care service, and communication between the referral hospitals and the primary care physicians, in particular. Such a development of services is the ultimate goal for improving care. But the immediate goal of the program is to make possible better education for the patients and their family to live with terminal cancer.

말기 암 환자에서 임상변수를 이용한 생존 기간 예측

염창환,최윤선,홍영선,박용규,이혜리,Yeom, Chang-Hwan,Choi, Youn-Seon,Hong, Young-Seon,Park, Yong-Gyu,Lee, Hye-Ree 한국호스피스완화의료학회 2002 한국호스피스.완화의료학회지 Vol.5 No.2

목적 : 의학의 발달로 인간의 생존 기간이 길어졌지만, 암 발생율과 사망율은 오히려 증가하고 있어 그로 인해 말기 암 환자는 계속 늘어나고 있는 실정이다. 말기 암 환자를 진료하는 데 있어서 환자의 생존 기간을 예측하는 것은 중요한 문제로 만약 환자의 생존 기간을 예측할 수 있다면 남은 시간에 따라 환자, 가족, 의료진은 치료의 선택에 큰 차이를 보일 것이다. 이에 저자 등은 말기 암 환자에서 사망 위험도를 높이는 예후 인자를 알아내고 이들 예후 인자의 개수에 따른 생존 기간을 예측하여 말기 암 환자의 진료에 도움이 되고자 하였다. 방법 : 2000년 7월 1일부터 2001년 8월 31일 사이에 국민건강보험공단 일산병원 가정의학과에 말기 암으로 입원한 환자 157명을 대상으로 입원당시 환자의 임상변수 31가지를 조사하였다. 그리고 환자의 의무기록과 조사된 환자의 신상기록을 가지고 2001년 10월 31일까지의 환자의 생존 여부를 확인하였다. Kaplan-Meier 방법과 로그순위 검정(log-rank test)을 이용하여 임상변수에 따른 생존 기간에 차이가 있는지를 알아보았다. Cox의 비례위험함수 모형(Cox's proportional hazard model)을 이용하여 임상변수 중 사망 위험도를 높이는 유의한 변수를 얻은 후 이를 예후 인자로 삼고, 이것을 와이블 비례위험함수 모형(Weibull proportional hazard function model)을 이용하여 예후 인자들의 유무에 따른 생존 기간의 평균, 중앙값 제 1사분위수 그리고 제 3사분위수를 계산하여 생존기간을 예측하였다. 결과 : 말기 암 환자 157명 중 성별은 남자가 79명(50.3%), 여자가 78명(49.7%)이었고, 평균 연령은 남자가 $65.1{\pm}13.0$세, 여자는 $64.3{\pm}13.7$세였다. 암의 종류를 보면 위암이 36명(22.9%)으로 제일 많았고, 폐암이 27명(17.2%), 대장암이 20명(12.7%) 순이었다. 의식변화, 식욕부진, 저혈압, 수행능력 저하, 백혈구 증가증, 중성구 증가증, 크레아티닌 증가, 저알부민혈증, 고빌리루빈혈증, 간효소(SGPT)치 증가, 프로트롬빈 시간(PT) 연장, 활성부분 트롬보플라스틴 시간(aPTT) 연장, 저나트륨혈증, 고칼륨혈증 등을 보이는 환자는 통계학적으로 유의하게 생존 기간이 짧았다. 이중 Cox의 비례위험함수 모형을 통해 수행능력 저하, 중성구 증가증, PT 연장, aPTT 연장인 경우가 환자의 사망위험도를 높이는 유의한 예후 인자로 나왔다. 생존 기간의 중앙값은 4가지 인자가 모두 있는 경우는 3.0일, 3가지만 있는 경우는 $5.7{\sim}8.2$일, 2가지만 있는 경우는 $11.4{\sim}20.0$일, 1가지만 있는 경우는 $27.9{\sim}40.0$일, 4가지 모두 없는 경우는 77일로 나왔다. 결론 : 말기 암 환자에서 수행능력 저하, 중성구 증가증, PT 연장, aPTT 연장이 사망위험도를 높이는 예후 인자임을 알 수 있었다. 이들 4개 인자를 통해 말기 암 환자에서 생존 기간을 예측할 수 있을 것으로 사료된다. Purpose : Although the average life expectancy has increased due to advances in medicine, mortality due to cancer is on an increasing trend. Consequently, the number of terminally ill cancer patients is also on the rise. Predicting the survival period is an important issue in the treatment of terminally ill cancer patients since the choice of treatment would vary significantly by the patents, their families, and physicians according to the expected survival. Therefore, we investigated the prognostic factors for increased mortality risk in terminally ill cancer patients to help treat these patients by predicting the survival period. Methods : We investigated 31 clinical parameters in 157 terminally ill cancer patients admitted to in the Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital between July 1, 2000 and August 31, 2001. We confirmed the patients' survival as of October 31, 2001 based on medical records and personal data. The survival rates and median survival times were estimated by the Kaplan-Meier method and Log-rank test was used to compare the differences between the survival rates according to each clinical parameter. Cox's proportional hazard model was used to determine the most predictive subset from the prognostic factors among many clinical parameters which affect the risk of death. We predicted the mean, median, the first quartile value and third quartile value of the expected lifetimes by Weibull proportional hazard regression model. Results : Out of 157 patients, 79 were male (50.3%). The mean age was $65.1{\pm}13.0$ years in males and was $64.3{\pm}13.7$ years in females. The most prevalent cancer was gastric cancer (36 patients, 22.9%), followed by lung cancer (27, 17.2%), and cervical cancer (20, 12.7%). The survival time decreased with to the following factors; mental change, anorexia, hypotension, poor performance status, leukocytosis, neutrophilia, elevated serum creatinine level, hypoalbuminemia, hyperbilirubinemia, elevated SGPT, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), hyponatremia, and hyperkalemia. Among these factors, poor performance status, neutrophilia, prolonged PT and aPTT were significant prognostic factors of death risk in these patients according to the results of Cox's proportional hazard model. We predicted that the median life expectancy was 3.0 days when all of the above 4 factors were present, $5.7{\sim}8.2$ days when 3 of these 4 factors were present, $11.4{\sim}20.0$ days when 2 of the 4 were present, and $27.9{\sim}40.0$ when 1 of the 4 was present, and 77 days when none of these 4 factors were present. Conclusions : In terminally ill cancer patients, we found that the prognostic factors related to reduced survival time were poor performance status, neutrophilia, prolonged PT and prolonged am. The four prognostic factors enabled the prediction of life expectancy in terminally ill cancer patients.

An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

Do Yeun Kim,Sang Min Lee,Kyoung Eun Lee,Hye Ran Lee,김지현,Keun-Wook Lee,Jong Seok Lee,Soon Nam Lee 대한암학회 2006 Cancer Research and Treatment Vol.38 No.4

Purpose: We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not- resuscitate (DNR) consent on the use of intravenous nutrition during the patient’s last week of life and at the time of death.Materials and Methods: The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient’s last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated.Results:In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient’s surrogates did not have any effect on reducing the use of parenteral nutrition.Conclusion: The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care. (Cancer Res Treat. 2006;38:214-217)

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

Chang, Yoon-Jung,Kwon, Yong Chol,Lee, Woo Jin,Do, Young Rok,Lee, Keun Seok,Kim, Heung Tae,Park, Sook Ryun,Hong, Young Seon,Chung, Ik-Joo,Yun, Young Ho Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Objectives: Terminal cancer patients and their caregivers often experience traumatic stress and need many types of assistance. In the present study we interviewed terminally ill cancer patients and caregivers to determine how much burden they experienced and to find out what factors are most important for satisfaction. Design: We constructed a questionnaire including overall care burden and needs experienced, and administered it to 659 terminal cancer patients and 659 important caregivers at 11 university hospitals and 1 national cancer center in Korea. Results: Finally, 481 terminal cancer patients and 381 caregivers completed the questionnaire. Care burden was not insubstantial in both and the caregiver group felt more burden than the patient group (P<0.001). While the patient group needed financial support most (39.0%), the caregiver group placed greatest emphasis on discussion about further treatment plans (44.8%). Stepwise multiple logistic regression analyses showed that in the patient group, patient's health status (OR, 2.03; 95%CI, 1.16-3.56) and burden (OR, 2.82; 95%CI, 1.76-4.50) influenced satisfaction about overall care, while in the caregiver group, high education level (OR, 1.84; 95%CI, 1.76-4.50), burden (OR, 2.94; 95%CI, 1.75-4.93) and good family function (OR, 1.94; 95%CI, 1.24-3.04) were important. Conclusions: Our study showed that burden was great in both terminal cancer patients and their caregivers and was perceived to be more severe by caregivers. Our study also showed that burden was the factor most predicting satisfaction about overall care in both groups.

말기 암환자 가족의 부담감에 관한 연구

장숙랑,이선자 대한보건협회 2000 대한보건연구 Vol.26 No.1

The objective of study is to investigate the degree of burdens of family as a pilot study focused on the plan about reducing burdens of family caring for terminal cancer patient and the settlement of hospice concept capable of managing the patient and family, and to analyze the burden level according to socio-demographic, economic, and medical factors in family. August 1, 1998 to November 1 1998., 85 terminal cancer patients and their main caregivers in family were included in our study, and the question survey were performed by concrete questionnare including general characteristics of patient and family, medical aspects of patient, economic state of family, degree of medical cost, and questions for family's burden. The burden score of main caregiver in family is 54.48 and the older were patient and main caregiver, the higher was the burden score. Time, self-advancement, economic burden were especially high among 6 area of burden. In cases of woman caregiver, believer in a religion, daughter caregiver, the burden is significantly low. Among medical characteristics, prolonged illness duration, absence of patient's insight heightened the burdens. Family's burdens according to economic factors were not significant, but in case of medical cost of above 5,000,000 won, caregiver's burdens were significantly increased. As a conclusion, the hospice concept must settle down in our country for the patient's family as well as the terminal cancer patient in order to reduce the burden of family care giver. The various social support system is needed to manage terminal cancer patients for their family.

말기 암 환자에서 수행능력에 따른 삶의 질 비교

채진성,정규철,김선현,염창환,Chae, Jin-Sung,Jung, Gyou-Chul,Kim, Sun-Hyun,Yeom, Chang-Hwan 한국호스피스완화의료학회 2005 한국호스피스.완화의료학회지 Vol.8 No.2

목적: 의학의 발달에도 불구하고 암 환자의 발생과 더불어 사망률은 점점 더 증가하고 있는 실정이다. 그러므로 암의 완치도 중요하지만 환자의 남은 삶에 대한 가치와 의미는 더욱더 중요하게 대두되고 있다. 이에 저자 등은 본 연구를 통해 말기 암 환자들이 수행능력에 따라 삶의 짚 신체적, 정신적 증상에 어떤 차이가 있는지를 보고자 하였다. 방법: 2003년 9월 1일부터 2005년 8월 31일까지 관동의대 명지병원 가정의학과에 내원한 암 환자를 대상으로 수행능력 상태, 인구통계학적 자료, 혈액검사, 삶의 질을 평가하였다. 수행능력을 두 군으로 나누어 혈액검사, 삶의 질에 차이가 있는지를 ANOVA를 통해서 분석하였다. P값이 0.05이하일 때 의미 있는 것으로 하였다. 결과: 대상이 된 환자는 총 104명이고, 수행능력 상태가 $0{\sim}1$인 경우 71명(남자 23명, 여자 48명), $2{\sim}4$인 경우 33명(남자 8명, 여자 25명)이었다. 혈액 검사를 보면 수행능력 상태가 $2{\sim}3$기일수록 림프구, 헤모글로빈, 단백질, 알부민, 나트륨 수치가 의미 있게 낮았다. 삶의 질을 평가 해 보면 수행능력 상태가 $2{\sim}4$일수록 전반적인 건강 상태(P=0.02)가 나빴다. 또한 수행능력 상태가 $2{\sim}4$일수록 기능적인 측면에서는 신체적 점수(P=0.05)와 역할 점수(P=0.01)가 나빴고, 증상적인 측면에서는 식욕부진(P=0.01)이 의미 있게 차이가 났다. 결론: 수행능력이 떨어지면 혈액검사 상 일부 영양과 관련된 수치가 떨어지고, 전반적인 건강상태가 나빠진다. 그러나 증상에서는 식욕부진을 제외한 나머지 것에는 차이가 없게 나왔다. 결론적으로 수행능력이 떨어진 환자에서 식욕을 증진시키는 것이 가장 중요하다고 생각한다. Purpose: Despite the advance of medical science, the number of cancer patient have increased and the mortality rate is also on the rise. Therefore, a perfect cure for cancer is crucial, but the value and meaning of the remaining life for the patient are also becoming more and more important. The principal aim of this study is to examine the differences in the quality of life, physical and psychosocial symptoms according to the performance status of terminal cancer patients. Methods: We evaluated the performance status, demographical data, blood analysis and quality of life of cancer patients who visited the Department of family Medicine at Myoung-ji Hospital in Korea between September 1, 2003 and August 31, 2005. Their performance status (ECOG) was divided into two groups ($ECOG\;0{\sim}1/ECOG\;2{\sim}4$) and analyzed by ANOVA to see if there was a difference in their blood analysis and quality of life. A P value of less than 0.05 was considered to be significant. Results: A total of 104 patients were evaluated, among which 71 patients (23 male and 48 female) scored $0{\sim}1$, and 33 patients (8 males and 25 females) scored $2{\sim}4$ in the ECOG. The blood analysis showed that patients whose performance status was $2{\sim}4$ had lower levels of lymphocytes, hemoglobin, protein, albumin and sodium. The evaluation on their quality of life showed that the overall health status of patients with $2{\sim}3$ functional ability were poor (P=0.02). Also, from a functional perspective, these patients had poor physical (P=0.05) and role (P=0.01) scores, and in terms of symptoms, they showed a significant loss of appetite. Conclusion: If a patient's performance status was poor, levels related to certain nutritions were also found to fall in blood tests, thereby leading to an overall weakened state of health. However, there was no difference in symptoms except for a loss of appetite. In conclusion, it is most important to increase the appetite in patients with poor performance status.

입원 말기암 환자가 지각한 가족지지와 삶의 질의 관계

주명진(Ju Myoung Jean),손수경(Sohn Sue Kyung) 대한종양간호학회 2008 Asian Oncology Nursing Vol.8 No.1

Purpose: This study was to identify the relationship between perceived family support and quality of life in hospitalized patient with terminal cancer. Method: Study subjects were 104 patients with terminal cancer who were hospitalized and treated at K university hospital, in Busan. Perceived family support and quality of life were measured using the Kang’s Revised Family Support Scale and Youn’s Quality of Life scale for terminal patients. Results: 1) The mean score of perceived family support was 4.23±0.61. The mean score of quality of life was 5.83±1.37. 2) The perceived family support was significantly different with primary care giver, food type, medical period after diagnosis. 3) The levels of quality of life was significantly different by number of children, effect of religion on the one’ life, perceived state of disease and pain. 4) There was moderate positive correlation between perceived family support and quality of life. Conclusions: Increase in perceived family support was associated with increase in quality of life in hospitalized patients with terminal cancer. It is necessary that the development of nursing education program for family which help to support the patient with terminal cancer for increasing the quality of life of patient with terminal cancer.

Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study

박은주,박권오,김재준,오상보,정기선,오소연,홍윤정,김진혁,장주연,전웅배 대한암학회 2021 Cancer Research and Treatment Vol.53 No.3

Purpose The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access.Materials and Methods Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death).Results A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, ‘a little comfort’ or ‘much comfort’) compared with the usual IV arm (21%) (p <0.001). Conclusion Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.

고용량과 저용량의 몰핀을 쓰는 말기 암 환자에서 임종 1주일동안 비교

조두연,차규진,윤방부,염창환,Cho, Doo-Yeoun,Cha, Kyu-Jin,Yoon, Bang-Boo,Yeom, Chang-Hwan 한국호스피스완화의료학회 2002 한국호스피스.완화의료학회지 Vol.5 No.1

배경 : 통증은 암 환자에서 가장 두려운 증상중의 하나이다. 암 환자의 $65{\sim}85%$가 통증을 경험하였고, 이들 환자에게 때에 따라서는 고용량의 몰핀이 사용되기도 한다. 그러나 많은 의사들은 아직까지 몰핀에 대한 두려움을 가지고 있어, 고용량의 몰핀을 쓰는 데 주저하고 있다. 이에 저자 등은 말기 암 환자에서 몰핀 사용에 대한 실태조사를 통해 몰핀 용량에 따른 차이가 있는지 여부를 알아보고자 하였다. 방법 : 2000년 7월 1일부터 2001년 12월 31일까지 경기도 고양시 소재 일개 종합병원 가정의학과에 입원하여 1주일 이상 생존하였다가 임종한 암 환자 99명을 대상으로 환자의 인구통계학적인 자료 임상 병리 검사, 몰핀 사용 용량 등을 조차하였다. 몰핀은 사용 용량에 따라 OME(oral morphine equivalent)로 계산하여 150 mg이하면 저용량으로 150 mg 초과면 고용량 군으로 나누어, 나이, 성별, 암의 종류, 전이 여부, 몰핀의 부작용 등의 측면에서 두 군간의 차이가 있는 지를 ch-square test를 통해 분석하였다. 결과 : 평균 연령에서는 저용량군이 $65.0{\pm}13.1$세, 고용량군이 $59.9{\pm}11.6$세였고, 성별은 저용량군이 남자 32명(50.0%), 여자 32명(50.0%), 고용량군은 남자 15명(51.7%), 여자 14명(48.3%)이었다. 암의 종류를 보면 두 군 다 위암이 제일 많았고, 그 다음으로 폐암 순이었다. 전이 여부에서는 저용량군 중 58명(90.6%), 고용량군 중 28명(96.6%)에서 전이가 있었다. 기타 완화적 목적의 방사선 치료나 부작용 측면에서 두 군간의 차이는 없었다. 결론 : 암 환자에서 임종 1주일 동안 몰핀 용량에 따른 차이는 없었다. 그러므로 말기 암환자를 치료하는데 있어 고용량 몰핀 사용을 주저할 필요는 없다. Background : Pain is one of the most feared consequences of cancer. $65{\sim}85%$ of cancer patients experienced severe pain, and sometimes high dose morphine is used to these patients. But many doctors still have 'opioid-phobia' and hesitate to use high dose morphine. We investigated the morphine therapy in terminal cancer patients during the last 1 week to death, and found any differences according to the morphine dosage. Methods : 93 patients admitted to National Health Insurance Corporation Ilsan Hospital, department of family medicine for hospice care between September 2000 and the end of October 2001 and lived more than 1 week entered in the study. We investigated the demographic data, laboratory tests and sufficient dosage of morphine for pain control. According to the calculated dosage by OME(oral morphine equivalent), patients were divided into low dosage group (${\leq}150mg/day$) and high dosage group (>150 mg/day). The chi-squared test were used to evaluate the influence of age, gender, tumor sites, metastasis and adverse effects of morphine. Results : Mean age was $65.0{\pm}13.1year$ in low dosage group and $59.9{\pm}11.6year$ in high dosage group. 32 men (50.0%) and 32 women (50.0%) were included in low dosage group and 15 men (51.7%) and 14 women (48.3%) in high dosage group. Stomach was the most frequent tumor site and lung was the next. Metastasis were found 58 (90.6%) in low dosage group and 28 (96.6%) in high dosage group. In other palliative radiotherapy and adverse effects, there were no differences in both group. Conclusion : During the last 1 week to death in cancer patients, there were no difference according to the morphine dosage. So we don't have to have 'opioid-phobia' in treating the terminal cancer patients.

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>