의료인의 호스피스가정간호에 대한 지식과 태도 조사연구

김옥겸,Kim, Ok-Gyeom 한국호스피스협회 2002 호스피스 학술지 Vol.2 No.2

The advances of medical technologies have not only prolonged human life span, but also extended suffering period for the patients with incurable medical diseases. Hospice movement was developed to help these patients keep dignity and lives peaceful at the end of their life. Since many patients prefer to spend the last moment of life at home with their family, hospice home care has become very popular worldwide. The purpose of this study for a promotion and development of hospice home care in Korea, and features basic research on medical profession's knowledge and attitudes to hospice home care. This study which was used for the research questionnaires developed by the researcher that were answered by 100 physicians and 127 nurses in a general hospital. Data were collected from April 22, 2002 to May 10, 2002. The SPSS was used to make a comparative analysis of the frequency, percentile, ANOVA, and x2-test. The results of the study were as follows; 1.The medical profession showed high level of knowledge of the definition and philosophy of hospice. However, the physician group of the examinees showed insufficient knowledge of the fact that hospice care includes bereavement care, while the nurse group's response to the same question showed a significant difference(x2=10.752, p=.001). 2.For whom the hospice home care is provided, 95.6% of the respondents showed very high level of knowledge as answering that the incurable terminal illness patients and their families are the beneficiaries of hospice care. The respondents counted nurses, volunteers, pastors, physicians and social workers, consecutively, as hospice care providers. More nurse were positive toward pastors than physicians in regarding as a hospice care provider by a significant difference(x2=11.634, p=.001). 3.For when to referral hospice home care to the patients, only 34.2% answered that patients with less than 6 months of survival time are advised to receive hospice care, reflecting very low level of knowledge. 23.0% of the physicians and 48.0% of the nurses answered that hospice care should be provided when death is imminent, making a significant difference between the two groups(x2=6.413, p=.000). 4.To promote hospice activities, 87.2% pointed out that it is crucial to make general people, including those engaging in the medical field, more aware of hospice. 79.7% answered that a national hospice management should be developed, marking a significant difference between the physician group and nurse group(x2=10.485, p=.001). 5.Advantages of hospice home care are 87.2% responded that patients can have better rest at home receiving hospice home care. Economical merit was brought forward as one of the advantages also, where there was a significant difference between the physicians group and nurse group(x2=7.009, p=.008). 6.The medical professions' attitude to hospice home care are 92.8% of the physicians answered that they would advise incurable terminally ill patients to be discharged from hospital, with 44.3% of them advising the patients to receive hospice home care after leaving the hospital. From the nurses' point of view, 20.9% of the terminally ill patients are being referred to hospice home care after discharge, which makes a significant difference from the physicians' response(x2=19.121, p=.001). 7. 30.6% of physicians have referred terminally ill patients to hospice home care, 75.9% of whom were satisfied with their decision. Those physicians who have never referred their patients to hospice home care either did not know how to do it(66.7%) or were afraid of losing trust by giving the patients an impression of giving up(27.3%). 94.9% of the physicians responded that they would refer their last stage patients to a doctor who is involving palliative care. 8.Only 36.2% of nurses have suggested to physicians that refer the terminally ill patients discharged from the hospital to hospice home care. Once suggested, 95.8% of the physicians have accepted the suggestion.

일부 지역주민들의 호스피스에 대한 인지와 태도 및 간호요구 조사

노유자,한성숙,안성희,용진선,Ro, You-Ja,Han, Sung-Suk,Ahn, Sung-Hee,Yong, Jin-Sun 한국호스피스완화의료학회 1999 한국호스피스.완화의료학회지 Vol.2 No.1

목적 : 본 연구는 일부 지역 주민들의 호스피스에 대한 인지와 태도 및 호스피스 간호 요구를 조사하고, 호스피스에 대한 인지와 태도에 따른 호스피스 간호요구를 파악하기 위함이다. 방법 : 1998년 9월부터 10월까지 서초구에 거주하는 $20{\sim}60$세의 성인 남녀 924명을 대상으로 하였으며, 자료는 자기보고식 설문지를 통하여 수집되었고, t-test와 ANOVA를 사용하여 분석하였고 Scheffe test로 다중비교를 하였다. 결과 : 1) 연구대상자의 평균연령은 38세였고, 대부분이 고학력자였다. 2) 호스피스에 대한 인지에서, 호스피스에 대해 들어 본 경험이 있다고 한 경우가 54.1%(501명)였으며, 그 중에서 64%가 여성이었고, 고졸 이상 학력자가 90.7%이었다. 죽음을 미리 준비해야 한다고 생각하는가에 대하여는 약 74%가 긍정적 대답을 하였다. 암과 같은 불치병에 걸린다면 의료인이 그 사실을 말해주기를 원하는가에 대해서는 약 83%가 원한다고 답하였다. 불치병에 걸린 사람에 대한 간호에 대해서는 63.1%가 고통을 최소로 줄이고 편안한 죽음을 맞이할 수 있도록 신체적, 정신적, 영적인 간호를 제공해야한다고 응답하였다. 3) 호스피스에 대한 태도에서, 필요시 호스피스 간호를 받겠다고 한 경우가 약 73.8% 이었고, 말기환자를 돌보는 방법으로는 기정에서 호스피스 팀의 방문을 받으며 돌보는 것이 33.5%로 가장 높았다. 4) 호스피스 간호요구를 영역별로 보면, 신체적 요구(M=4.37)가 가장 높았고 사회적 요구(M=3.96), 정서적 요구(M=3.87), 영적 요구(M=3.79)순이었으며, 전체 요구도는 평균 약 4.00점으로 호스피스에 대한 높은 요구를 보였다. 인구학적 특성별로는, 50세 이상의 연령층과 기혼자들에서 요구도가 가장 높았고, 남성보다 여성이 높았으며, 종교별로는 가톨릭의 경우 요구도가 가장 높았다. 호스피스 간호 요구도는 호스피스에 대해 들어본 경험, 죽음에 대한 준비, 불치병에 대한 통고 및 호스피스의 필요성 인식에 따라 유의한 차이를 보였다. 즉, 호스피스에 대해 들어본 군, 죽음을 미리 준비해야 된다고 전적으로 긍정한 군, 불치병에 대한 통고를 원하는 군, 그리고 필요시에 호스피스 간호를 받겠다는 군에서 호스피스 간호 요구도가 유의하게 높았다. 결론 : 본 연구의 결과는 호스피스에 대한 인지정도를 높일 수 있는 홍보와 교육이 필요함을 시사하며, 지역사회 주민들의 요구를 충족시켜 삶의 질을 향상시키기 위한 가정 호스피스를 발전시키고 나아가서는 전반적인 호스피스 발전을 위한 유용한 자료가 될 것으로 기대된다. Purpose : The hospice movement began about 30 years ago in Korea. However, basic studies have seldom been conducted about the general public's knowledge concerning hospice care and their needs for it. The purpose of this study was to investigate the general public's knowledge of and attitude toward hospice, and their needs for hospice care, and to analyze the needs for hospice care in relation to their knowledge and attitude in residents from a specific community. Methods : The survey was conducted with 924 people randomly selected from a district in Seoul. The data were collected through a self-reporting questionnaire constructed by the authors. With 30 items given in the questionnaire, the level of hospice needs showed Cronbach's alpha .89 in a pilot study and .92 in this study and the items were classified into four areas by a factor analysis. The data collected were analyzed by means of t-test and ANOVA. Results : 1) The average age of the respondents was 38. The majority of the respondents were well-educated. 2) Regarding awareness of hospice care, 54%(501 people) indicated they have heard of hospice. About 74% thought that people should be able to prepare for death in advance. About 83% wanted to be informed when they have life threatening illnesses such as terminal cancer. Also, about 63% responded that patients with terminal diseases should be provided with physical, spiritual, and psychological care for minimizing pain and peaceful death. Regarding the attitude toward hospice care, 74% responded that they would use hospice care if needed. The number of the respondents who preferred home visitation by the hospice team to care for the terminally ill ranked first with 34%. Concerning needs for hospice care : 1) By needs area, physical need showed highest mean(M=4.37), followed by social need(M=3.96), emotional need(M=3.87), and the spiritual need(M=3.79). The overall need level showed the mean value of 4.00 which reflects a considerable need for hospice care. 2) By demographic characteristics, people age over 50, the married, and the unemployed indicated higher level of needs for hospice care. Women showed higher level of needs than did men, and Catholics demonstrated higher level of needs than believers of other religion(P<0.0001). 3) As for the knowledge of and attitude toward hospice rare, the level of hospice care needs was significantly higher in the following groups: those who have heard of hospice, those who are aware of death preparation, those who want information on terminal diseases, those who want to use every method to sustain life, and those who are aware of hospice needs(P<0.001). Conclusion : It is assumed that the findings of this study on the knowledge, attitude, and needs for hospice care in the public can contribute to planning a successful hospice care program. Furthermore, the findings of this study will serve as useful data for the promotion of home hospice care to improve the quality of life of community residents, and contribute to the development of hospice care as a whole.

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.

Attitudes towards Death, Perceptions of Hospice Care, and Hospice Care Needs among Family Members of Patients in the Intensive Care Unit

Oak, Yunha,Kim, Young-Sun Korean Society for Hospice and Palliative Care 2020 한국호스피스.완화의료학회지 Vol.23 No.4

Purpose: This study aimed to identify the relationships among attitudes towards death, perceptions of hospice care, and hospice care needs as perceived by family members of patients in the intensive care unit (ICU). Methods: This study used a descriptive correlational method. A structured questionnaire was used to collect data from 114 participating families in the ICU at Dong-A University Hospital, from October 10 to November 1, 2019. The data were analyzed in terms of frequency, percentage, and mean and standard deviation. The t-test, one-way analysis of variance, and Pearson correlation coefficients were also conducted. Results: Perceptions of hospice care showed significant differences according to age (F=3.06, P=0.031) and marital status (t=3.55, P=0.001). However, no significant differences in attitudes towards death or hospice care needs were found. A significant positive correlation was found between perceptions of hospice care and hospice care needs (r=0.49, P<0.001). Conclusion: In order for families to recognize the need for hospice care and to receive high-quality palliative care at the appropriate time, it is necessary to increase public awareness of hospice care through various educational and awareness-raising efforts, thereby providing opportunities for families of terminally ill patients to request hospice care.

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.

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.

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.

가정 호스피스케어환자 방문간호 조사분석

이소우,이은옥,박현애,오효숙,안효섭,허대석,윤영호,김달숙,노유자,Lee, So-Woo,Lee, Eun-Ok,Park, Hyun-Ae,Oh, Hyo-Sook,Ahn, Hyo-Seop,Huh, Dae-Suk,Yun, Young-Ho,Kim, Dal-Sook,Rho, Yoo-Ja 한국호스피스완화의료학회 1998 한국호스피스.완화의료학회지 Vol.1 No.1

목적 : 오늘날 호스피스 운동은 만성질환자가 급격히 증가함에 따라 인간의 삶을 추구하여 이루어낸 가장 완벽한 대답의 하나가 되고 있다. 우리의 1996년, 1997년의 연구에서 말기환자와 그 가족들에 대한 조사를 통해 한국 호스피스의 현재 상황을 파악하였다. 또한 호스피스케어 팀과 자원봉사자와 호스피스환자 관리를 위한 정보서비스 시스템을 개발하였다. 본 연구는 호스피스 정보서비스 시스템를 통한 간호사의 가정방문 호스피스케어와 그 문제점을 분석하였다. 방법 : 1997년 10월 1일부터 1998년 3월 31일까지 서울대학교병원 등에서 의뢰받은 26명의 말기암환자를 대상으로 하였다. 데이터 베이스와 홈페이지를 통해 호스피스케어에 필요한 정보를 갖춘 호스피스 정보서비스 시스템을 인터넷을 통해 방문간호사에게 제공하였고 방문간호사들은 이 시스템을 교육받고 환자 방문시 노트북 컴퓨터를 소지하여 호스피스 정보서비스 시스템을 통해 호스피스케어를 제공하였으며 첫 방문시와 호스피스케어동안에 환자들의 신체적 심리적 사회적 자료를 수집하였다. 결과 : 연구기간동안 26명중 16명이 사망하였으며 사망자의 평균 생존기간은 20.7일이었다. 첫 방문시 식욕부진(96.2%), 거동장애(88.5%), 통증(84.6%)이 주요한 증상이었으며 226개의 간호진단 중 영양부족과 통증이 가장 흔한 진단이었다. 가족은 환자보다 호스피스케어를 더 잘 이해하고 더 요구하였다. 대부분의 환자와 가족들은 간호사에게 영적 사회적 간호를 요구하지 않았다. 결론 : 시범사업을 통해 환자와 방문 호스피스 간호사에게 통증과 영양 관리에 대한 보다 많은 정보를 제공하여야 하여야 함을 알 수 있었다. 호스피스 정보서비스 시스템은 영적 사회적 케어에 대한 정보와 인력을 보안되어질 필요가 있다. Purpose : Hospice Care is considered as one of the most perfect solutions for the problems brought up as the number of chronically ill patients are increasing rapidly and most of social welfare oriented countries are seeking the quality of life. Our former studies(1996, 1997) were to find out the current status of the hospice care in Korea by surveying terminally ill patients and their family members as well as medical professionals. The former study was also to conduct the operation research by developing an information service system for training of hospice care teams and volunteers, and hospice patients management. The purpose of this study was that hospice information service system was tested by home visiting hospice care through visiting nurses. Methods : From October 1, 1997 to March 31, 1998, Twenty six terminal cancer patients were included in this study from Seoul National University Hospital and other hospital. Databases and homepage, hospice information service system were designed and developed for the information needed for the hospice care before this study by our research team and this services were available through the internet. Visiting nurses were trained about this system and they visited the patients with PC notebook and provided them hospice care with hospice information system. They collected physical, psychiatric, social data of the subjects at the first visit and during hospice care at home. Results : Sixteen subjects(61.5%) died during the study and the mean survival was 20.7 days. Anorexia(96.2%), immobility(88.5%) and pain(84.6%) were the major symptom in the 26 subjects, Altered nutrition(26.1%) and pain(12.4%) were the most frequent diagnoses in 226 nursing diagnoses of the subjects. Families understood and demanded the hospice care more than patients. And most patients and families didn't demand spiritual or social care. Conclusion : Through this demonstration study, it was found that we have to provide the information of pain management and nutritional support for patients by the nurses and visiting hospice nurse. The information service system needs to be upgraded with information and manpower of spiritual and social care according to the findings.

‘연명의료결정법’에 대한 생사학적 비판

오진탁 충남대학교 인문과학연구소 2017 인문학연구 Vol.56 No.4

Life-sustaining medical treatments have been one of the important social issues over the past 20 years or so since the withdrawal of life-sustaining medical treatment at Boramae Medical Center in 1997. In February, 2016, the National Assembly passed the bills for Hospice and Palliative Care and Life-sustaining Medical Decision Law for dying patients. The law focusing on life-sustaining medical withdrawal decision and hospice and palliative care, is also called ‘Well-dying law.’ Well-Dying is a comprehensive concept, which promotes a deeper understanding of death and consideration of different methods of death. However, life-sustaining medical withdrawal decision indicates no more than halting the life-sustaining medical treatment. It does not mean a beautiful end itself. Life-sustaining Medical Decision Law, in Article 2, Clause 6, it states “Hospice and Palliative Care means medical care conducted in physical, socio-psychological, and spiritual areas with a purpose of comprehensively evaluating and treating dying patients.” There should to be a more definite investigation into why ‘spiritual’ was mentioned here. According to WHO, hospice care is haracterized by holistic care on physical, socio-psychological, and spiritual areas. Spiritual care makes it possible for a dying patient to overcome the fear of death and face death comfortably and with dignity. But the law, while stating clearly that Hospice and Palliative Care means medical care conducted in physical, psychological, and spiritual areas with a purpose of comprehensively evaluating and treating dying patients, never mentions a comprehensive understanding of death. In hospice, spiritual aspect does not come after spiritual care, but WHO suggests because there is a spiritual aspect in death, spiritual care becomes important. Therefore, the fact that hospice professional manpower does not include professionals in spiritual care is not the only problem. The law does not clearly suggest a comprehensive, holistic approach to death. Regarding this contemporary circumstances, Kubler-Ross, the founder of life and death studies, also notes that “it is because there is no definition of death in a true sense.” In preparing the Life-sustaining Medical Decision Law, our society only focused on the issues of life-sustaining medical treatments withdrawal and its medical and legal ramifications, ignoring the aspect of spiritual care. For the need for spiritual care, we should take a more comprehensive approach to death and an insightful understanding to death. It is only when we look at hospice care and death through a holistic approach in physical, socio-psychological, and spiritual aspects that we can understand the need for spiritual care. 최근 20여 년간 연명의료 중단문제가 사회적 이슈가 되었다. ‘호스피스·완화의료 및 임종 과정에 있는 환자의 연명의료 결정에 관한 법률’이 2016년 2월 국회를 통과했다. ‘말기환자의 연명의료 중단 결정과 호스피스 완화의료’에 초점을 맞춘 이 법은 ‘웰다잉법’으로 일컬어지고 있다. 웰다잉은 ‘아름다운 마무리’를 추구하므로, 죽음에 대한 깊이있는 이해 모색과 임종방식에 대한 심사숙고 등 보다 포괄적인 개념이다. 하지만 연명의료 중단결정은 치료 가능성이 없는 환자의 연명의료를 중단하자는 것일 뿐이다. 이 법의 제2조 6항에서는 “호스피스·완화의료란 말기환자에게 신체적, 심리사회적, 영적 영역에 대한 종합적인 평가와 치료를 목적으로 하는 의료”라고 했다. 왜 ‘영적인’ 영역을 제시했는지 보다 분명한 검토가 필요하다. WHO에 따르면 호스피스 돌봄은 신체적, 사회심리적, 영적인 전인적 돌봄을 특징으로 한다. 영적 돌봄은 임종과정 환자에게 죽음의 불안을 극복하고 품위 있는 죽음을 맞이할 수 있게 한다. 그러나 이 법에서 호스피스 완화의료는 신체적, 사회심리적, 영적 영역에 대한 종합적인 치료를 목적으로 한다고 분명히 밝혔으면서, 죽음에 대한 포괄적인 이해를 한 번도 언급하지 않았다. 호스피스에 영적인 돌봄이 있어서 죽음에 영적인 측면이 있는 게 아니다. 죽음에 영적인 측면이 있기에, 호스피스에서도 영적인 돌봄이 중요하다고 WHO는 제시한 것이다. 그러므로 죽음에 대한 총체적 접근이 ‘연명의료결정법’에 분명히 제시되고 있지 않은 게 문제다. 생사학을 창시한 퀴블러로스도 이런 현대적 상황에 대해 “죽음 정의가 없기 때문”이라 한다. 우리 사회는 연명의료 중단결정의 문제, 이에 대한 의학적, 법률적 논의에만 초점을 맞추었고 영적 돌봄은 도외시했다. 세계보건기구 규정대로 호스피스 돌봄과 죽음을 신체적, 심리사회적, 영적 측면에서 총체적으로 바라볼 때, 비로소 영적 돌봄이 요구된다.