의식 없는 말기환자 가족의 연명치료 중단 결정 경험 = Family Decision-Making to Withdraw Life-Sustaining Treatment for Terminally-Ill Patients in an Unconscious State

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study is to understand family members' experience of deciding to withdraw life-sustaining treatments for terminally-ill patients in an unconscious state. Methods: Data were collected by performing an in-depth interview with eight terminally-ill patients' family members who decided to withdraw life-sustaining treatments. Colaizzi's phenomenological method was used for data analysis. Results: Questions were classified into 12 groups and finally into five categories. The five categories were about family members' frustration with patient's condition, emotional preparation for the patient's death upon medical professionals' recommendation, patient's wishes, exhaustion due to caring and past experiences related to life-sustaining treatment. Conclusion: Using the five categories, hospice and palliative professionals could better understand family members' decision making experience of withdrawing life-sustaining treatments for terminally-ill patients. Based on that, the family members could be provided with appropriate counseling and care, which in turn could improve hospice and palliative care intervention.

국문 초록 (Abstract)

목적: 본 연구의 목적은 의식 없는 말기환자 가족의 연명치료 중단 결정 경험을 이해하기 위함이다. 방법: 자료는 의 없는 말기환자의 연명치료 중단 결정을 한 8명의 가족으로부터 심층면담을 통해 수집하였다. Colaizzi의 현상학적 분석 방법이 자료 분석을 위해 사용되었다. 결과: 주제는 12개의 주제모음으로 분류되었고, 12개의 주제모음은 마침내 5개의 범주로 통합되었다. 5개의 범주는 환자상태로 인한 절망감, 의료진의 권고에 마음을 비움, 환자의 바램, 돌봄으로 인한 가족의 소진, 연명치료와 관련된 과거의 경험이었다. 결론: 다섯 개의 범주를 통하여 의식 없는 말기환자 가족의 연명치료 중단 결정 과정에서 발생할 수 있는 현상들을 이해함으로써 적절한 상담과 간호를 제공하여 보다 바람직한 호스피스 완화의료 중재가 필요하다고 본다.

참고문헌 (Reference)

1 송태준, "한 대학병원 종양내과에서 사망한 환자들의 심폐소생술 금지 지시 결정 요소" 대한내과학회 74 (74): 403-410, 2008

2 김계순, "연명치료중단에 대한 의료인의 민사적 책임" 민주주의법학연구회 (38) : 137-162, 2008

3 윤영호, "바람직한 임종을 위한 호스피스•완화의료 및 사회적 대책" 대한의사협회 52 (52): 880-885, 2009

4 Heo DS, "Withholding futile interventions from terminally ill cancer patients" 44 : 956-962, 2001

5 Koh YS, "Withdrawal of life-sustaining treatment for patients who are terminally ill" 45 : 650-652, 2002

6 Kim JH, "Treatment withdrawal: characteristics of critically ill patients and experience of primary caregivers" Yonsei Univ 2002

7 Weiss GL, "The do-not-resuscitate decision: the context, process, and consequences of DNR orders" 24 : 307-323, 2000

8 Lautrette A, "Surrogate decision makers for incompetent ICU patients: a European perspective" 14 : 714-719, 2008

9 Shin KR, "Qualitative research methodology" Ewha Womans Univ Comp 2004

10 Colaizzi PF, "Psychological research as the phenomenologist views it, In Existenial-phenomenological alternatives for psychology" Oxford University Press 48-71, 1978

11 Kwon SH, "Patient’s decision-making rights on ceasing treatments for prolongation of life" Dong-A Univ 2009

12 Heo DS, "Overview and issues" 77 (77): S1026-S1034, 2009

13 Parse RR, "Man-living-health: a theory of nursing" Willy 1981

14 Baggs JG, "Intensive care unit cultures and end-of-life decision making" 22 : 159-168, 2007

15 Wilson DM, "Highlighting the role of policy in nursing practice through a comparison of “DNR” policy influences and “no CPR” decision influences" 44 : 272-279, 1996

16 McPherson CJ, "Family caregivers’ assessment of symptoms in patients with advanced cancer: concordance with patients and factors affecting accuracy" 35 : 70-82, 2008

17 Jang SO, "Experience of family with DNR and change of care after DNR decision-making in intensive care units" Gyeongsang National Univ 2000

18 Park YO, "Experience of family members on deciding to withdraw life-sustaining treatment for patients who are terminally ill" Yonsei Univ 2003

19 Kim SK, "Experience of family & nurse related to the process of DNR decision" Yonsei Univ 2006

20 Sohn MS, "Ethical and legal aspect of termination of hospital care" 41 : 707-711, 1998

21 Guba EG, "Effective evaluation" Josscy- Bass Publishers 1981

22 한성숙, "DNR(Do-Not-Resuscitate)에 대한 의사와 간호사의 경험 및 인지도" 간호행정학회 11 (11): 255-264, 2005

23 Pence GE, "Classic cases in medical ethics: accounts of cases that have shaped medical ethics, with philosophical, legal, and historical backgrounds. 3rd ed" McGraw-Hill 29-51, 2000

24 Park CS, "An attitude of the withholding treatment" Catholic Univ 2004

25 Kang YS, "A study on decision making of DNR: focused on caner patient’s cases" Sungkyunkwan Univ 2005