호스피스 관련 국내 간호연구 논문 동향(1998~2017)

김원순 한국호스피스완화의료학회 2019 한국호스피스.완화의료학회지 Vol.22 No.1

Purpose: In this study, the hospice nursing research trend in 1998~2017 was investigated by analyzing research articles on hospice nursing. Methods: Literature search was performed with keywords of ‘nursing’ and ‘hospice on an academic research information service. Also reviewed were all articles published in the Korean Journal of Nursing Science and its 8 subcategory journals, the Korean Journal of Hospice and Palliative Care and the Korean Hospice Association from 1998 through 2017, except thesis papers. Results: In 2013~2017, 79 articles (31.0%) were relevant, up over 7% from 61 articles (23.9%) in 2008~2012. The most studied field was psychology (92 papers, 36.2%) in the Korean Journal of Hospice and Palliative Care. Enrolled in most papers were patients with end-stage cancer (75, 29.5%), which is overwhelmingly high. Most studies used quantitative methods (183, 72.0%). Recognition was the most studied theme (62, 24.4%), and 16 of them focused on recognition of death (6.3%). Intervention studies totaled 34 (13.4%), and most of them (7, 2.8%) were conducted for palliative education. Conclusion: Most hospice nursing studies were quantitative studies, conducted with patients, and hospice nursing intervention programs were similar to each other. Thus, more studies with hospice patients and their families are needed. And more experimental and qualitative studies are needed to build an evidence-based nursing study environment. Considering how most studies examined psychological factors, physiological factors such as pain, a major issue in hospice care, should be analyzed in experimental studies to construct a pain intervention program for hospice patients. 목적: 본 연구는 1998년부터 2017년까지 수행된 호스피스 간호연구논문을 분석한 서술적 조사연구이다. 방법: 주요 검색어는 ‘호스피스’, ‘간호’였으며(마지막 검색일: 2018 년 3월 30일) 검색은 학술연구정보서비스(www.riss4u.net)를 통해선정되었으며, 더불어 한국간호과학회지 및 8개 분과 학회지와 한국 호스피스·완화의료학회지와 한국호스피스협회지에 1998년부터2017년까지 게재된 논문 모두를 검토하였으며, 학위논문은 제외하여 자료를 수집하였다. 결과: 1998년부터 2002년에 51편(20.0%)이었던 논문이 2013년부터 2017년에는 79편(31.0%)으로 약 11% 이상 급증하였으며 호스피스간호 학문분야별로 심리학 분야가 92편(36.2%)으로 가장 많았으며 다음으로 간호학 분야가 46편(18.1%)로 나타났다. 연구 대상자별로 분석한 결과 말기암환자가 72편(28.3%)으로 압도적으로 많았다. 이외에 1편(0.4%)은 HIV 바이러스, AIDS 환자였으며 아동 말기암환자도 2편(0.8%)으로 나타났다. 연구 방법은 양적 연구는 183 편(72.0%)으로 가장 많았으며 다음으로 질적 연구 22편(8.7%)으로많았다. 실험 중재는 총 34편(13.5%)으로 호스피스교육프로그램이7편(2.8%) 가장 많이 진행되었다. 결론: 호스피스 간호연구의 대상자는 대부분 환자에 치중되어있었으며 소수 호스피스대상자와 가족대상자의 연구가 적어 소수의 호스피스대상자와 가족대상의 연구가 활발히 진행될 필요가 있다. 연구 방법은 양적 연구가 대부분으로 나타나 향후 근거기반의 간호연구 환경의 조성을 위하여 순수 실험연구와 질적 연구의 활성화가 필요하다. 더불어 연구주제가 심리적 변수가 대부분으로 나타나 호스피스대상자의 주요 간호문제인 통증 등의 생리적 변수를 적용한 실험 연구가 활성화되어 대상자의 통증중재프로그램방안의 모색이 필요하다.

호스피스 자원봉사자들의 말기 AIDS 환자들에게 자원봉사를 제공할 의향에 영향을 미치는 요인

윤석준,최영심,정진규,김종성,류혜원 한국호스피스완화의료학회 2017 한국호스피스.완화의료학회지 Vol.20 No.4

Purpose: With the implementation of the Act on Life Sustaining Treatment, hospice-palliative care will be extended to non-cancer diseases including the acquired immunodeficiency syndrome (AIDS). However, there are concerns about negative perceptions and prejudice toward AIDS patients. The purpose of this study was to investigate factors related with willingness to volunteer (WV) for patients with end-stage AIDS among hospice volunteers. Methods: Participants were 326 hospice volunteers from 19 institutions. A self-administered questionnaire was employed to investigate the participants’ WV for end-stage AIDS patients, and the questions were answered using an 11-point rating scale. Demographics, volunteer activity, satisfaction with hospice volunteering, knowledge of AIDS, and attitudes towards AIDS patients (i.e., fear AIDS patients, negative attitude towards AIDS patients, personal stigmatization and stigmatizing attitude) were also investigated. A multiple regression analysis was performed to examine factors associated with WV for patients with end-stage AIDS. Results: WV for patients with end-stage AIDS was 2.82 points lower than that for cancer patients (P<0.001). The multiple regression analysis showed that the higher the level of satisfaction with hospice volunteering (P=0.002) and the lower the level of “personal stigmatization” (P<0.001), participants showed greater WV for end-stage AIDS patients. Conclusion: The level of satisfaction with hospice volunteering and “personal stigmatization” were factors associated with participants’ WV for patients with end-stage AIDS. 목적: ‘연명의료결정법’의 시행으로 호스피스 완화의료의 대상이 암뿐 아니라 후천성면역결핍증(acquired immunodeficiency syndrome, AIDS)을 포함한 비암성 질환에까지 확대된다. 하지만, AIDS에 대해서는 부정적인 인식과 낙인, 편견이 많아 호스피스 완화의료 확대에 대한우려가 많다. 이에 본 연구에서는 말기 AIDS 환자들에대한 자원봉사 제공의향 정도에 영향을 주는 요인들을알아보고자 하였다. 방법: 우리나라의 19개 기관의 326명의 호스피스 자원봉사자들을 대상으로 자가 기입식 설문지를 이용해조사하였다. 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도는 11단계 숫자등급을 통해 파악하였다. 인구사회학적 변수들, 자원봉사와 관련된 변수들, 자원봉사에대한 만족도, AIDS에 대한 지식 수준, AIDS에 대한 태도(‘AIDS 환자에 대한 두려움’, ‘AIDS 환자에 대한 부정적인 태도’, ‘개인적인 낙인’, ‘낙인적 태도’)를 조사하였다. 다중회귀분석을 이용하여 말기 AIDS 환자들에 대한자원봉사 제공의향 정도에 영향을 주는 요인들을 알아보았다. 결과: 말기 AIDS 환자들에 대한 자원봉사 제공의향정도 점수는 암환자에 대해서보다 평균 2.82점 낮았고이는 통계적으로 유의하였다(P<0.001). 다중회귀분석결과 자원봉사에 대한 만족도가 높을수록(P=0.002) ‘개인적인 낙인’ 점수가 낮을수록(P<0.001) 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도는 높아졌다. 결론: 본 연구의 결과 호스피스 자원봉사자들의 말기AIDS 환자들에 대한 자원봉사 제공의향 정도와 관련이있는 요인은 자원봉사에 대한 만족도와 AIDS에 대한 태도 중 ‘개인적인 낙인’이었다.

Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients

Ye-seul Kim,한은아,이재우,강희택 한국호스피스완화의료학회 2022 한국호스피스.완화의료학회지 Vol.25 No.2

Purpose: We compared cost-effectiveness parameters between inpatient and homebased hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospicepalliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice- palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

텍스트네트워크분석을 활용한 호스피스완화돌봄 연구의 지식구조 및 시기별 연구동향

장선희(Sun-Hee Jang),염동문(Dong-Moon Yeum) 한국산학기술학회 2021 한국산학기술학회논문지 Vol.22 No.10

목적: 본 연구는 텍스트네트워크분석을 통해 국내의 호스피스완화돌봄 키워드를 중심으로 지식구조 및 시기별 동향을 탐색하고 향후 호스피스완화돌봄 연구에 필요한 기초자료를 제공하고자 시도되었다. 방법: 본 연구는 RISS, NDSL를 이용하여 1988년부터 2021년 3월까지 총 1,103편 논문을 분석하였다. 공동연구자간 여러 차례 협의를 통한 정제한 후 360개 유사어, 1,293개 제외어를 등록하였고, 키워드의 중요도를 파악하기 위해 연결정도 크기를 반영한 단어구름, 빈도, 연결중심성, 근접중심성, 매개중심성을 중심으로 분석하였다. 분석 시기는 연명의료결정법이 제정된 2016년 기점으로 1988년~2015년을 1기, 2016년~2021년 3월을 2기로 설정하였고, 자료분석은 NetMine 4를 이용하였다. 결과: 핵심키워드 네트워크 비교 및 시각화를 통해 호스피스완화돌봄 논문에서 출현빈도가 높은 핵심어는 care, patient, death, life, family, program, treatment, effect, education 등의 순으로 나타났다. 세 가지 중심성에서 상위 10위내에 공통으로 나타나는 중심핵심어는 care, patient, death, life, family, program, treatment, hospital, terminal 등으로 나타났다. 시기별 네트워크 비교분석에서 계속해서 상위 10위내에 나타나는 중심핵심어 이외에 1기에만 출현한 키워드는 cancer, pain, development, questionnaire, management, time, 2기에만 출현한 용어는 act, life sustaining, decision, experience, End of Life, service 등 이었다. 결론: 텍스트네트워크분석을 활용하여 키워드를 중심으로 방대한 양의 텍스트 자료에서 미시적 주제를 파악하여 연구 주제의 지식구조를 살펴보았으며, 본 연구를 통해 분석된 중심핵심어가 향후 호스피스완화돌봄 실무 발전에 기초자료가 될 수 있을 것으로 기대한다. Purpose: This study sought to identify and compare hospice-palliative care research topics using text network analysis. Method: This study analyzed a total of 1,103 papers from 1988 to March 2021 using Regional Information Sharing Systems (RISS) and NDSL. After several consultations among the researchers, 360 synonyms and 1,293 excluded words were registered. To further identify the importance of keywords, word clouds reflecting the size of the proximity degree, frequency, degree centrality, closeness centrality, and betweenness centrality were analyzed. The two periods were separated as of the year 2016 when the "Life-Sustaining Treatment Decision-making Act" was enacted. Result: Hospice-palliative care papers published in national academic journals analyzed focusing on core keywords, network comparison and visualization, had the following keywords with high frequency: Care, patient, death, life, family, program, treatment, hospital, terminal, among others. Fourteen of the most important core keywords ‐ care, patient, death, life, family, et al. ‐ were common between the two periods, whereas cancer, pain, development, questionnaire, management from pre-2016 studies and the above Act, life-sustaining, decision, experience, end of life, service from post-2016 ranked more highly. Conclusion: Through this study, it is expected that the core words analyzed through the study will be the cornerstone for the future practice of hospice-palliative care.

호스피스⋅완화의료 발전사와 한의학 참여의 필요성

윤해창,손창규,이남헌,조정효 대한한방내과학회 2018 大韓韓方內科學會誌 Vol.39 No.4

Objective: The aim of this study was to establish the developmental history of hospice⋅palliative care (HPC) with Korean medicine (KM). Methods: We compared the developmental history of HPC in Korea with that of Britain, the United States, Taiwan, Japan, and China. The articles in English or Korean published until Feb. 2017 were searched using ‘Hospice' or ‘Palliative care' with the name of each nation in the PubMed, MEDLINE, ScienceDirect, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases for foreign articles and OASIS (Oriental Medicine Advanced Searching Integrated System) for domestic articles. Books and gray literature were searched on the same databases and websites of the Ministry of Health and Welfare and related organizations in each country. Results: Modern palliative care began with the hospice movement led by Dr. Cicely Saunders. HPC in Korea started earlier than in other countries but it took considerable time for social consensus, so Korean policies have only been published recently. In this process, KM was excluded from HPC. For this reason, western medicine in Korea does not fully accept the spirit of HPC, the government does not take an aggressive stance with KM, and the institutes of KM do not have any interest in HPC. The World Health Organization recommends the establishment of policies and programs connected with a country’s own health care system. In 2015, the Korean government made the third comprehensive plan for the development of KM. It included critical pathway guidelines about cancer-related fatigue and anorexia. More effort is required to set up HPC than other care types because Korea has two medical systems. Conclusions: Each nation has been trying to improve systems of HPC. We need to overcome the problems and bring out the best by making our own model of HPC with KM.

호스피스·완화의료 발전사와 한의학 참여의 필요성

윤해창,손창규,이남헌,조정효,Yoon, Hae-chang,Son, Chang-gue,Lee, Nam-heon,Cho, Jung-hyo 대한한방내과학회 2018 大韓韓方內科學會誌 Vol.39 No.4

Objective: The aim of this study was to establish the developmental history of hospice palliative care (HPC) with Korean medicine (KM). Methods: We compared the developmental history of HPC in Korea with that of Britain, the United States, Taiwan, Japan, and China. The articles in English or Korean published until Feb. 2017 were searched using 'Hospice' or 'Palliative care' with the name of each nation in the PubMed, MEDLINE, ScienceDirect, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases for foreign articles and OASIS (Oriental Medicine Advanced Searching Integrated System) for domestic articles. Books and gray literature were searched on the same databases and websites of the Ministry of Health and Welfare and related organizations in each country. Results: Modern palliative care began with the hospice movement led by Dr. Cicely Saunders. HPC in Korea started earlier than in other countries but it took considerable time for social consensus, so Korean policies have only been published recently. In this process, KM was excluded from HPC. For this reason, western medicine in Korea does not fully accept the spirit of HPC, the government does not take an aggressive stance with KM, and the institutes of KM do not have any interest in HPC. The World Health Organization recommends the establishment of policies and programs connected with a country's own health care system. In 2015, the Korean government made the third comprehensive plan for the development of KM. It included critical pathway guidelines about cancer-related fatigue and anorexia. More effort is required to set up HPC than other care types because Korea has two medical systems. Conclusions: Each nation has been trying to improve systems of HPC. We need to overcome the problems and bring out the best by making our own model of HPC with KM.

연명의료결정법의 문제점 및 개선 방안

김명희 한국호스피스완화의료학회 2018 한국호스피스.완화의료학회지 Vol.21 No.1

보라매 사건 이후 근 20년이 지나 국가위원회의 권고를 기반으로 연명의료결정법이 2018년 2월 4일 제정 시행되었다. 그러나 법률의 제정 과정에서 이해관계 당사자 및 관련자들의 의견 차이로 일부 내용은 수정 또는 삭제되었으며 제정 막바지에 호스피스 완화의료에 대한 내용이 덧붙여졌다. 이로 인해 국가위원회의 권고에 담긴 내용과는 일부 다르게 법률이 제정되어 여러 문제점들이 나타나고 있다. 그러므로 현행 법률 시행 초반 연명의료결정 수행 현장을 꼼꼼히 모니터링하고 다양한 관련자들의 의견을 잘 청취하여 문제점을 파악하고 해결 방안을 마련하여야 할 것이다. 이를 토대로 법률을 개정하여입법 목적인 ‘환자의 최선의 이익을 보장하고 자기결정을 존중하여인간으로서의 존엄과 가치를 보호’가 충실히 이루어질 수 있도록 하여야 할 것이다. Nearly 20 years after the Boramea Hospital case, the act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life has taken effect on February 4, 2018 as recommended by the National Bioethics Committee. However, during the legislation process, some parts of the bill that stakeholders and concerned parties did not see eye to eye were either revised or removed. Moreover, the hospice and palliative care part was added in the last minute before the enactment. As a result, the law includes parts that are not in line with the recommendations from the National Bioethics Committee, thereby causing various problems. Therefore, it is crucial to monitor how the decisions on life-sustaining treatments are made in the field and gather various opinions of concerned parties to identify and address problems in the early stage of the implementation of the law. Based on the data, the legislation must be amended to fulfill its purpose that is “to protect the dignity and value of human beings by assuring the best interests of the patients and by respecting their self-determination”.

연명의료 관련 신문 기사의 텍스트네트워크분석

박은준,안대웅,박찬숙 한국지역사회간호학회 2018 지역사회간호학회지 Vol.29 No.2

Purpose: This study tried to understand discourses of life-sustaining treatments in general daily and healthcare newspapers. Methods: A text-network analysis was conducted using the NetMiner program. Firstly, 572 articles from 11 daily newspapers and 258 articles from 8 healthcare newspapers were collected, which were published from August 2013 to October 2016. Secondly, keywords (semantic morphemes) were extracted from the articles and rearranged by removing stop-words, refining similar words, excluding non-relevant words, and defining meaningful phrases. Finally, co-occurrence matrices of the keywords with a frequency of 30 times or higher were developed and statistical measures―indices of degree and betweenness centrality, ego-networks, and clustering―were obtained. Results: In the general daily and healthcare newspapers, the top eight core keywords were common: “patients,” “death,” “LST (life-sustaining treatments),” “hospice palliative care,” “hospitals,” “family,” “opinion,” and “withdrawal.” There were also common subtopics shared by the general daily and healthcare newspapers: withdrawal of LST, hospice palliative care, National Bioethics Review Committee, and self-determination and proxy decision of patients and family. Additionally, the general daily newspapers included diverse social interest or events like well-dying, euthanasia, and the death of farmer Baek Nam-ki, whereas the healthcare newspapers discussed problems of the relevant laws, and insufficient infrastructure and low reimbursement for hospice-palliative care. Conclusion: The discourse that withdrawal of futile LST should be allowed according to the patient’s will was consistent in the newspapers. Given that newspaper articles influence knowledge and attitudes of the public, RNs are recommended to participate actively in public communication on LST.

Comparison of the Hospice Systems in the United States, Japan and Taiwan

이정렬,Hiroko Komatsu,Weihua Zhang,Yann-Fen Chao,김기경,김광숙,조윤희,Ji Sook Ko 한국간호과학회 2010 Asian Nursing Research Vol.4 No.4

Purpose The aim of hospice care is to provide the best possible quality of life both for people approaching the end of life and for their families and carers. The Korean government has been implementing a pilot project for hospital hospice services and trying to develop the national hospice system. To assist in the development of the Korean hospice system, the Korean government supported the present study comparing the hospice systems of three countries, United States, Japan, and Taiwan, which currently have a developed hospice system. Methods Data from three countries were collected in the following ways: reviewing hospice related literature,searching government documents on the Internet, collecting government hospice data, surveying six hospice institutions in each country, and conducting an international workshop. Results The hospice system was evaluated by comparing hospice management systems and hospice cost systems. The comparison of the hospice management system included five items of hospice infra structures and four items of hospice services. The hospice cost system included four items: funding source,hospital hospice cost, day care hospice cost, and home hospice cost. Conclusions Based on the comparison of three countries, the most interesting thing was that home hospice care accounted for more than 90% of all hospice services in the United States and Taiwan. The results of this study will aid the countries that are in the process of developing a hospice system including Korea,which has been implementing a pilot project only for hospital hospice services. [Asian Nursing Research 2010;4(4):163–173]

Design of a Hospice Referral System for Terminally Ill Cancer Patients Using a Standards- Based Health Information Exchange System

임가현,김정훈,유수영,허은영,지혜림,강버들 대한의료정보학회 2018 Healthcare Informatics Research Vol.24 No.4

Objectives: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.