강원도 거주 성인의 사전연명의료의향서에 대한 인식

홍정주,이미옥 한국컴퓨터정보학회 2020 韓國컴퓨터情報學會論文誌 Vol.25 No.5

This study was attempted to know the awareness of Advance Directives of adults in Gandwon-do province. Data was surveyed from 60 adults in Gangwon-do province by 42 item questionnaire for the awareness of Advance Directives. Subcategories of Advanced Directives questionnaire were knowledge, preference, experience for life-sustaining treatment and Advance Directives. The data was analyzed with the frequency and percentage using SPSS 24.0. 45% of Participants replied they knew the ‘life-sustaining treatment’ exactly. They preferred CPR 78.3%, mechanical ventilation 63.3% and blood transfusion 51.7% for their future special life-sustaining treatments. They did not preferred hemodialysis 8.3%, artificial respiration 6.7%, intensive care unit 6.7%, 8.3 percent of participants said that they well aware of Advance Directives. 86.6% of them hoped to write their Advance Directives. Despite such low awareness of the Advance Directives, the intention to write Advance Directives was high. Based on these results, it was found that the level of awareness of Advance Directives was very important for the intention to prepare Advance Directives. Therefore, regional programs and education on Advance Directives and periodic survey study for awareness of Advance Directives should be continued. 본 연구는 강원도에 거주하는 성인의 사전연명의료의향서에 대한 인식을 알고자 시도되었다. 연구 자료는 강원도에 거주하는 성인 60명을 대상으로 42문항의 구성된 사전연명의료의향서 설문지를 이용하여 수집되었다. 연구 자료는 SPSS 24.0 프로그램을 이용하여 빈도와 백분율을 분석하였다. 사전연명의료의향서 인식의 설문지는 연명치료와 사전의료의향서의 지식, 경험, 선호도로구성되었다. 연구 결과는 다음과 같았다. 연구 참여자의 45%가 연명치료에 대해 정확이 알고 있다고 응답하였다. 연구 참여자가 선호하는 특수연명치료는 심폐소생술 78.3%, 기계 환기 63.3%, 수혈 51.7% 이었다. 연구 참여자가 피하고 싶어 하는 특수 연명치료는 신장투석 8.3%, 인공호흡6.7%, 중환자실 입원 6.7%로 나타났다. 사전연명의료의향서에 대해서는 8.3%만 인지하고 있었으며, 그럼에도 불구하고 응답자의 86.6%가 사전연명의료의향서 작성에 호의적이었다. 본 연구 참여자의 사전연명의료의향서에 대한 인식은 매우 낮았음에도 불구하고 이를 준비하겠다는 의도는 높았다. 따라서 이러한 결과를 기반으로 사전연명의료의향서에 대한 인식 수준이 사전의료의향서작성의도에 매우 중요함을 알 수 있다. 따라서 사전연명의료의향서에 대한 지역 프로그램과 교육과 주기적인 사전연명의료의향서에 대한 인식 연구가 계속되어야 한다.

사전의사결정(Advance Directives, 死前意思決定)에 대한 사법연수원생들과 전공의와 수련의들의 인식도 조사

신영태 ( Young Tae Shin ),이일학 ( Il Hak Lee ),김선현 ( Sun Hyun Kim ),이희일 ( Hee Il Lee ) 한국의료윤리학회 2008 한국의료윤리학회지 Vol.11 No.1

Background: The legal and ethical issues related to advance directives have recently become controversial in Korea. This study was designed to determine whether there are any significant differences between judicial apprentices and medical trainees (including residents and interns) with respect to their attitudes toward advance directives. Methods: A questionnaire was administered to 283 judicial apprentices from May 29 to June 9, 2006, and to 254 medical trainees (150 residents and 104 interns) from May 1 to July 31, 2006. Thus, there were a total of 537 respondents in this study. Results: More medical trainees than judicial apprentices were familiar with advance directives (P < 0.05). More medical trainees than judicial apprentices claimed that a law for advance directives was necessary (P < 0.05). After adjusting for other predisposing factors, differences between the two groups were still statistically significant (P = 0.038). After adjusting other predisposing factors, it is found that the group which knew about advance directives beforehand responded more positively to the question whether legislation for advance directives was necessary than the group which didn`t(P=0.000). Conclusion: In this study, the difference in the number of medical trainees versus judicial apprentices who were familiar with advance directives was found to be statistically significant (P < 0.05). This caused statistically significant differences between the number of judicial apprentices versus medical trainees who believed that a law covering advance directives is needed. Therefore, greater awareness of advance directives is needed in order to establish a law governing them.

간호대학생의 사전의료의향서에 대한 태도 영향 요인

김희정(Kim, Hee-Jung) 한국간호교육학회 2019 한국간호교육학회지 Vol.25 No.2

Purpose: The purpose of this study was to identify nursing students’ knowledge and attitude toward advance directives and factors influencing the attitude. Methods: A cross-sectional survey design was used and 196 nursing students participated in the study. Data were collected from July 1 to August 30, 2018 using a structured questionnaire which included biomedical ethics, awareness of good death, knowledge and attitude toward advance directives. Data were analyzed using SPSS/WIN 25.0 program with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. Results: The mean score of biomedical ethics, awareness of good death, knowledge and attitude toward advance directives were 2.88±0.59, 3.18±0.48, 7.68±31.32, 31.00±3.09. Factors influencing the attitude toward advance directives were awareness of good death (β=.28, p<.001), intention of writing their advance directives (β=.19, p=.006), the knowledge related to advance directives (β=.15, p=.029). A total of 14% of attitude toward advance directives was explained by awareness of good death, the knowledge related to advance directives, and ntention of writing their advance directives. Conclusion: The findings of the study indicate that it is necessary to provide a systemic education program regarding advance directives for nursing students in order to provide knowledge related to advance directives and to help them establish positive attitudes toward advance directives.

중년기 급성심근경색증 환자의 죽음불안과 사전연명의료의향서에 대한 지식 및 태도 간의 관계

서미영(Suh, Mi Young),김정선(Kim, Jeong Sun) 한국노인간호학회 2021 노인간호학회지 Vol.23 No.3

Purpose: This study aimed to identify the relationship between death anxiety, knowledge, and attitudes toward advance directives in middle-aged patients with acute myocardial infarction. Methods: Data were collected through a survey of 142 middle-aged adults from August 27th to October 4th, 2019 in G city. Data analysis was performed using descriptive statistics, t-test, one-way ANOVA, Scheffé test, and Pearson correlation coefficient. Results: The average score of participants’ death anxiety and attitudes toward advance directives was 44.14±6.71 and 43.61±3.53, respectively, and the average correct rate in knowledge of advance directives was 57.1%. Participants showed significant differences in death anxiety (F=3.75, p=.013), knowledge of advance directives (F=3.02, p=.033), and attitudes toward advance directives (t=2.31, p=.022) depending on the presence or absence of an object to discuss their health status. Also, there were significant differences in knowledge of advance directives (t=3.43, p=.001) and attitude toward advance directives (t=2.23, p=.027) depending on whether participants perceived the meaning of advance directives. There were positive correlations (r=.38, p=<.001) between knowledge of advance directives and attitudes toward advance directives in middle-aged patients with acute myocardial infarction. Conclusion: Active information-provision and promotional strategies are needed to enhance a correct understanding of advance directives for middle-aged acute myocardial infarction patients with a high probability of sudden death to recognize the need for an advance directive and reinforce a positive attitude.

지역사회 노인의 사전연명의료의향 효능감이 사전연명의료의향서 작성에 미치는 영향: 사전연명의료의향 의도의 매개효과

김현숙,염계정 한국노인간호학회 2022 노인간호학회지 Vol.24 No.2

Purpose: The purpose of this study was to identify factors related to the completion of advance directives by community-dwelling older adults. Methods: This descriptive correlational study used a cross-sectional survey of 236 older adults recruited from a welfare center in Jungnang gu Seoul, South Korea. Data collection was done from June 1 to August 20, 2021. A self-administered questionnaire was used to measure advance directives' self-efficacy and intentions and the completion of advance directives. The data were analyzed with the SPSS 23.0 and SPSS Process Macro program. Results: Advance directives' self-efficacy indirectly had a significant positive effect on the completion of advance directives and fully mediated advance directives' intentions, and its explanatory power was confirmed to be 21%. Conclusion: The result of this study suggests developing education programs to improve the completion of advance directives in community-dwelling older adults. Further research is needed with more elderly populations in extended areas

사전의료지시의 한계

오세혁,정화성 대한의료법학회 2010 의료법학 Vol.11 No.2

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

간호대학생의 사전의료의향서에 대한 지식과 간호전문직관이 사전의료의향서에 대한 태도에 미치는 영향

정은,정미라 한국융합학회 2019 한국융합학회논문지 Vol.10 No.6

This study were to identify the effect of knowledge on advance directives and nursing professionalism on attitudes toward advance directives in nursing students. The data were collected from 216 nursing students in the two colleges located Jeonnam.. The result of the multiple regression indicates the intention to execute advance directives, influence of religion in one`s life, knowledge of advance directives, gender, nursing professionalism, and time to complete advance directives predict 22.3%(F=10.009, p=.000) of attitudes toward advance directives. Therefore, it is necessary to develop a program to establish positive attitudes toward advance directives by providing knowledge on advance directives and right nursing professionalism of nursing students. 본 연구는 간호대학생의 사전의료의향서에 대한 지식과 간호전문직관이 사전의료의향서에 대한 태도에 영향을 미치는 요인을 규명하기 위함이다. 본 연구의 참여자는 전라남도 2개 대학교에 재학 중인 간호대학생을 대상으로 하였으며, 최종 216부를 분석하였다. 다중 회귀분석 결과 사전의료의향서에 대한 태도에 영향을 미치는 요인은 사전의료의향서 작성여부, 종교가 삶에 미치는 영향, 사전의료의향서에 대한 지식, 성별, 간호전문직관, 사전의료의향서 작성 시기로 이들의 설명력은 22.3%(F=10.009, P=.000)이었다. 본 연구결과를 바탕으로 간호대학생의 사전의료의향서에 대한 지식과 올바른 간호전문직관을 제공함으로써 사전의료의향서에 대한 긍정적인 태도 확립을 위한 프로그램 개발이 필요할 것으로 생각된다.

일 지역 성인의 호스피스 인식과 사전의료의향서에 대한 지식과 태도의 관계

박경란,장선희 대한통합의학회 2019 대한통합의학회지 Vol.7 No.4

본 연구는 일 지역 성인의 호스피스 인식과 사전의료의향서에 대한 지식 및 태도를 파악하기 위한 서술적 상관관계 조사연구이다. 연구대상은 경상남도 C시에 거주하는 일반 성인이 221명을 대상으로 2018년 7월 5일부터 7월 15일까지 설문 조사를 실시하였으며, 210명을 최종자료로 분석하였다. 대상자의 호스피스 인식 정도는 4점 만점에 평균은 3.05점이었고, 사전의료의향서에 대한 지식은 9점 만점에 평균 7.49점이었으며, 사전의료의향서에 대한 태도는 4점 만점에 평균은 2.82점이었다. 대상자의 일반적 특성에 따른 호스피스 인식 정도는 경제적 수준, 종교의 중요성, 호스피스에 대해 들어 봄, 사전의료의향서에 대해 들어 봄, 사전의료의향서 작성의향에 따라 유의한 차이가 있었다. 대상자의 일반적 특성에 따른 사전의료의향서에 대한 지식 정도는 연령, 입원경험, 종교, 집안에 문제가 생겼을 때 최종 결정자, 사전의료의향서 작성의향에 따라 유의한 차이가 있었다. 대상자의 일반적 특성에 따른 사전의료의향서에 대한 태도는 결혼상태, 사전의료의향서 작성의향에 따라 유의한 차이가 있었다. 상관관계에 있어서는 호스피스 인식과 사전의료의향서에 대한 태도( =.47, p<.001), 사전의료의향서에 대한 지식과 태도 간에( =.20, p=.005) 유의한 양의 상관관계가 있었다. 이상의 결과를 종합해 볼 때, 호스피스 인식과 사전의료의향서 태도는 양적 상관이 있음이 확인되어 호스피스 인식과 사전의료의향서에 대한 지속적인 교육 및 범국민적 공감대를 활성화하는 것이 필요할 것이다. Purpose : This narrative research study aimed to identify the degree of correlation between hospice awareness and knowledge of and attitude toward advance directives. Methods : A survey was conducted from July 5 to July 15, 2018 with 210 adults in ​​C city, Gyeongsangnam-do. Using the SPSS 21.0 program, the data analysis methods utilized were the independent t-test, one-way ANOVA, Scheffe, and Pearson's correlation coefficients. Results : The degree of hospice awareness was measured according to the general characteristics of the subjects, which were as follows: heard about economic level, importance of religion, heard of hospice, heard about advance directives, and intention to execute advance directives. The knowledge of advance directives had significant differences by age, hospitalization experience, religion, and being the final decision maker for a family problem. The attitude toward advance directives differed significantly by marriage status and the intention to write an advance directives. The relationship between hospice awareness and knowledge and attitude toward advance directives showed a positive significant correlation (r=.47, p<001). The relationship between knowledge of and attitude toward advance directives also indicated a positive significant correlation (r=.20, p=.005). Conclusion : This study provided basic data to inform promotion of hospice awareness and an educational intervention about advance directives.

말기 신부전 환자에서 사전의사결정서의 적용

남양훈 ( Yang Hoon Nam ),서인석 ( In Suk Seo ),임지환 ( Ji Hwan Lim ),최준혁 ( Jun Hyuk Choi ),김장언 ( Jang Eon Kim ),최진호 ( Jin Ho Choi ),오지민 ( Ji Min Oh ),권규흠 ( Kyu Heum Kwon ),윤수진 ( Su Jin Yoon ),윤성민 ( Sung Min Y 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1

목적: 외국의 경우, 말기 질환자와 관련된 정책 지침이 신부전 환자의 보존적 치료의 질을 향상시키는데 적용되고 있다. 그러나, 우리나라는 고령 인구의 증가와 더불어 여러 합병증을 동반한 혈액 투석 환자의 수도 늘어났지만, 아직 말기 신부전 환자의 완화치료에 대한 뚜렷한 지침이나 권고안은 없다. 이에 우리는 혈액투석중인 말기 신부전 환자에게 사전의사 결정서를 의무적으로 작성하도록 하여, 삶의 마지막에 시행될 수 있는 심장폐소생술이나 신대체요법 등을 포함하는 각종 치료에 대해 미리 준비하며 스스로의 의견을 치료 결정에 반 영할 수 있도록 하고, 그에 따른 영향을 살펴보고자 하였다. 방법: 1) 본원에서 사용하도록 사전의사결정서를 개정하였다. 2) 서울의료원에서 2007년 1월부터 6월까지 혈액투석을 받는 환자에게 사전의사결정서를 기본의무기록으로 작성하도록 권고하여, 총 35명의 환자가 완성하였다. 3) 환자들은 자신의 삶의 마지막에 이루어질 치료에 대해 의사와 면담을 통해 설명을 듣고난 후 사전의사결정서를 작성하였다. 결과: 총 남자 23명과 여자 12명이 사전의사결정서를 작성하였다. 사전의사결정서는 환자의 삶의 마지막에 이루어질 치료에 대한 18개 항목을 포함하는 질문지 형태로 구성되었다. 혈액투석환자의 대부분이 심장폐소생술과 신대체요법에 대해 주치의의 결정에 따르겠다고 답하였다. 하지만, 8명 (67%)의 여성과 15명 (53%)의 당뇨환자, 그리고 11명 (52%)의 노인환자는 심장폐소생술을 거부한다고 밝혔다. 결론: 사전의사결정서를 기본의무기록으로 작성하도록 하는 것은 말기 신부전 환자의 삶의 마지막에 어떠한 치료를 시행할지 결정하는데 기본 자료를 제공할 것이다. 그리고, 사전의사결정서로 표현한 존귀한 죽음과 치료 계획에 대한 준비가 말기 신부전 환자에서 끝까지 삶의 질을 높게 유지할 수 있도록 도울 것이다. Purpose: In other countries, government guidelines related to chronic illness are being used to enhance supportive care of renal patients. In Korea, the number of old ages and hemodialysis patients with many complications has been increased. But we don`t have any guidelines for palliative care of end stage renal disease. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, renal replacement therapy) via routine use of advance directives in people with end stage renal disease undergoing hemodialysis. Methods: 1) We revised advance directives in Seoul Medical Center. 2) We recommended the routine use of advance directives to patients who were treated in hemodialysis room of Seoul Medical Center from Jan, 2007 to Jun, 2007. So 35 patients were enrolled. 3) They had been interviewed about end of-life treatment plans and filled up advance directives. Results: 23 males and 12 females in total were enrolled. The advance directives include 18 questions about patient preferences for treatment of end-of-life. The majority of hemodialysis patients replied I will follow doctor`s decisions including cardiopulmonary resuscitation and renal replacement therapy 8 females (67%), 15 diabetes (53%) and 11 geriatric patients above 60yrs old (52%), however, were against cardiopulmonary resuscitation. Conclusion: Routine use of advance directives will provide basic sources for end-of-life decisions in the care of end stage renal patients. And they would like to keep the high quality of life with the help of prepared therapeutic plan of care and well-dying presented advance directives.

상급종합병원 간호사의 사전연명의료의향서에 대한 지식, 자신감 및 교육요구도

장난순,박해숙,김미라,이주연,조여원,김경미,손연정 한국중환자간호학회 2018 중환자간호학회지 Vol.11 No.1

Purpose : Nurses’ knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses. Method : This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire. Results : The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses’ knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p ‹ .001) and learning needs (r = .16, p = .005). Conclusion : Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.