국내의 비암성 질환의 호스피스 완화의료 적용에 대한 전문가의 인식에 관한 질적 연구: 후천성 면역결핍 증후군, 만성 폐쇄성 폐질환, 간경화를 중심으로 = A Qualitative Study of Physicians' Perspectives on Non-Cancer Hospice-Palliative Care in Korea: Focus on AIDS, COPD and Liver Cirrhosis

국문 초록 (Abstract)

목적: 2017년 8월부터 말기 암 이외에도 후천성 면역결핍 증후군, 만성 폐쇄성 폐질환, 간경화 환자들에게도 호스피스 완화의료가 적용될 예정이다. 이에 본 연구에서는 비암성 질환 전문가들을 대상으로 세 가지 질환에서의 호스피스 완화의료의 목표, 내용 및 적용 방법에 대한 심층 면담을 통해, 호스피스 완화의료에 대한 생각, 인식, 태도에 대해 살펴보아, 국내 실정에 맞는 비암성 호스피스 완화의료 진료 모델 마련에 기여하고자 하였다. 방법: 본 연구는 반구조적 심층 면담조사를 통한 질적 연구이다. 암환자의 호스피스 완화의료를 담당하는 네 명의 임상 의사가 85편의 문헌 검색을 통해 핵심 질문을 선정하여 총 11명의 비암성 질환 전문가들에게 면담을 하고 질적 연구 방법에 따라 분석되었다. 결과: 전문가들은 비암성 질환의 말기환자를 정의하기 어렵다고 하였고, 호스피스 완화의료의 목표와 내용은 암환자들을 대상으로 한 것과 다르지 않다고 하였지만, 통증보다는 다른 신체 증상과 정서적 문제에 중점을 두어야 한다고 하였다. 또한, 말기라고 진단할 수 있는 시점에 호스피스 완화의료를 적용해야 한다고 하였다. 질환 별로 특수한 점들(AIDS 환자들의 항바이러스제 사용, COPD 환자들의 호흡곤란, LC 환자들의 간이식)과 의료진들에 대한 교육의 필요성에 대해 언급하였다. 호스피스 완화의료 적용 시 환자들이 자신을 포기한다는 느낌을 받을 수 있다고 하였고 정부의 재정 지원 문제에 대해서도 언급하였다. 결론: 비암성 질환에 대한 호스피스 완화의료 도입의 문제점을 최소화하기 위해서는 심도 있는 논의를 통해 비암성 질환의 말기환자에 대한 정의를 마련해야 할 필요가 있다. 또한, 비암성 말기환자들을 돌보는 의료진과 현재 말기 암환자의 호스피스 완화의료를 담당하고 있는 인력의 협력이 필요하다.

다국어 초록 (Multilingual Abstract)

Purpose: From August 2017, hospice-palliative care (HPC) will be provided to patients with acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and liver cirrhosis in Korea. To contribute to building a non-cancer (NC) hospice-palliative care model, NC specialists were interviewed regarding the goals, details, and provision methods of the model. Methods: Four physicians specializing in HPC of cancer patients formulated a semi-structured interview with questions extracted from literature review of 85 articles on NC HPC. Eleven NC disease specialists were interviewed, and their answers were analyzed according to the qualitative content analysis process. Results: The interviewees said as follows: It is difficult to define end-stage NC patients. HPC for cancer patients and that for NC patients share similar goals and content. However, emphasis should be placed on alleviating other physical symptoms and emotional care rather than pain control. Timing of the care provision should be when patients are diagnosed as "end stage". Special issues should be considered for each NC disease (e.g., use of anti-retroviral drugs for AIDS patients, oxygen supply for COPD patients suffering from dyspnea, liver transplantation for patients with liver cirrhosis) and education should be provided to healthcare professionals. NC patients tend to negatively perceive HPC, and the government's financial assistance is insufficient. Conclusion: It is necessary to define end-stage NC patients through in-depth discussion to minimize issues that will likely accompany the expansion of care recipients. This requires cooperation between medical staff caring for NC patients and HPC givers for cancer patients.

참고문헌 (Reference)

1 WHO, "definition of palliative care"

2 Kimbell B, "What is the patient experience in advanced liver disease? A scoping review of the literature" 5 : 471-480, 2015

3 Hess S, "Trends in specialized palliative care for non-cancer patients in Germany--data from the national hospice and palliative care evaluation (HOPE)" 25 : 187-192, 2014

4 Elo S, "The qualitative content analysis process" 62 : 107-115, 2008

5 Bettoncelli G, "The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)" 9 : 25-, 2014

6 Mathers CD, "Projections of global mortality and burden of disease from 2002 to 2030" 3 : e442-, 2006

7 Karus D, "Patient reports of symptoms and their treatment at three palliative care projects servicing individuals with HIV/AIDS" 30 : 408-417, 2005

8 Fausto JA Jr, "Palliative care in the management of advanced HIV/AIDS" 38 : 311-326, 2011

9 Lisotti A, "Palliative care in patients with liver cirrhosis: it is the time to deal with the burden" 5 : 466-467, 2015

10 Rocker G, "Palliation of dyspnoea in advanced COPD: Revisiting a role for opioids" 64 : 910-915, 2009

11 Ostgathe C, "Non-cancer patients in specialized palliative care in Germany: what are the problems" 25 : 148-152, 2011

12 "NHPCO’s facts & figures: hospice care in America"

13 Simms V, "Integration of palliative care throughout HIV disease" 12 : 571-575, 2012

14 Carlson MD, "Impact of hospice disenrollment on health care use and medicare expenditures for patients with cancer" 28 : 4371-4375, 2010

15 GOLD, "Global strategy for diagnosis, management, and prevention of COPD"

16 Dalgaard KM, "Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome" 12 : 495-513, 2014

17 Perry BA, "Characteristics of an ambulatory palliative care clinic for HIV-infected patients" 16 : 934-937, 2013

18 Corbin J, "Basics of qualitative research: Techniques and procedures for developing grounded theory" Sage 2008

19 Lanken PN, "An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses" 177 : 912-927, 2008

20 Higginson IJ, "An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness:a randomised controlled trial" 2 : 979-987, 2014

21 Rosenwax L, "A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on" 15 : 46-, 2016