Journal of hospice and palliative care最新文献

Purpose: This study aimed to identify predictors of end-of-life (EOL) care provided by emergency nurses in South Korea.

Methods: A cross-sectional survey was conducted using a structured questionnaire. Data were collected using Google Forms between June 21 and 30, 2022. A total of 154 emergency nurses from 10 tertiary hospitals in a metropolitan area were recruited using convenience sampling, and 139 completed surveys were analyzed. Multiple linear regression was employed to examine the effects of nurses' knowledge of life-sustaining treatment withdrawal (knowledge), their perceptions of their role in the withdrawal process (role perception), and job stress on EOL care.

Results: The mean scores for knowledge, role perception, job stress, and EOL care were 13.09±1.75 (max 6), 4.18±0.44 (max 5), 3.55±0.32 (max 4), and 2.48±0.40 (max 4), respectively. Among the EOL care subdomains, psychological domain scores were the highest. Multiple linear regression analysis indicated that nurses' role perception significantly predicted EOL care performance, particularly in the psychological (F=3.924, P=0.001) and spiritual (F=2.171, P=0.020) domains.

Conclusion: Despite the challenging environment of the emergency department, nurses who recognize their important role in the process of life-sustaining treatment withdrawal are more likely to provide high-quality EOL care. The perception of nurses' roles is especially influential on psychological care performance, and alternative approaches may be necessary for spiritual care.

Home-based palliative care (HBPC) has emerged as a critical model to address the complex needs of individuals with life-limiting illnesses, particularly in super-aged societies. This review explored the key components of HBPC and elaborated on its benefits, challenges, opportunities, and future directions, drawing on international evidence and practical frameworks. HBPC is reported to enhance the quality of life, reduce unnecessary hospitalizations, and increase the likelihood of patients dying in their preferred settings. Successful care delivery requires integrated multidisciplinary teams, effective symptom management, holistic care, and timely support from caregivers. However, barriers such as resource constraints, caregiver burden, and a lack of psychosocial support remain significant. Future directions and opportunities include integrating hospital-at-home models into routine HBPC services, strengthening the education of healthcare professionals and the public, and fostering compassionate communities to promote social engagement in end-of-life care. Advancing HBPC within diverse sociocultural contexts can bridge the gap between patient preferences and actual care delivery, offering a sustainable pathway to improve continuous palliative care provision for older adults globally.

Purpose: This study aimed to understand and explore the experiences of families of patients with cancer who died in a tertiary hospital providing palliative care consultation during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Semi-structured interviews were conducted with bereaved families of patients with cancer who received palliative care consultations during the COVID-19 pandemic in a tertiary hospital in Seoul. The data were analyzed using a phenomenological research method.

Results: During the COVID-19 pandemic, families experienced anxiety and guilt due to the limitations of caregiving opportunities and became aware of the lack of existing support systems. Thematic analysis revealed four essential themes family agitation in uncertainty, palliative care that gives strength in isolated situations, reflection on the indescribable loss, and appealing to the world regarding the desperate need for a support system.

Conclusion: During the pandemic, families struggled to express love and fulfill caregiving roles, with caregivers facing increased emotional pressure and burnout. Communication between patients, families, and medical staff and comprehensive support for family members' end-of-life preparation are necessary. This will serve as basic data for understanding the experiences of families of dying patients with cancer at tertiary hospitals in the non-face-to-face era and for end-of-life care, including palliative care consultations in healthcare settings.

Purpose: This study was conducted to identify the influence of hospice·palliative nursing knowledge, empathy, and attitudes toward end-of-life care on spiritual care competence of nurses in long-term care hospitals.

Methods: The participants was 174 nurses who had worked for more than one clinical year and experienced end-of-life care more than one time in 14 long-term-care hospitals in C province. Data were collected using questionnaires which consisted of hospice·palliative care knowledge, empathy, attitude toward end of life care, and spiritual care competence. Data were analyzed using the Statistical Package for the Social Science (SPSS) WIN 29.0 statistical program.

Results: The job satisfaction, education level, empathy and attitude toward end-of-life care explained 36.9% of spiritual care competence and major predictor variable for spiritual care competence was attitude toward end-of-life care of nurse.

Conclusion: Based on the results of this study, in order to improve the spiritual care competence of nurses in long-term care hospitals, it is necessary to consider education level among nurses and improve their job satisfaction. Also, in order to enhance their empathy and positive attitude toward end-of-life care, it is needed to develop and apply various systematic programs for nurses in long-term care hospitals.

Purpose: This study explored current pediatric palliative care (PPC) in South Korea and suggests future directions based on the perspectives of full-time PPC workers.

Methods: A mixed-methods secondary analysis was conducted using survey data from nurses and social workers involved in a government PPC project. The survey assessed services provided by hospitals, nurses, and social workers, and gathered perceptions of challenging tasks, evidence needs, the significance of PPC, and future expectations through open-ended questions. Data were analyzed using frequency and conventional content analyses.

Results: Eighteen full-time workers from nine of the ten project hospitals participated. Eight hospitals provided pain and symptom management and all offered counseling and education for patients and parents. Only one provided respite care and legacy-making services. Bereavement care was offered in all hospitals primarily through individual counseling and there were also three self-help groups. Nurses have diverse roles including in practice, education, leadership, research, and consultation. Social workers address psychosocial and economic challenges, rehabilitation and social reintegration. The workers highlighted the challenges in end-of-life care and communication, stressing the need for protocols and further training. PPC was seen as meaningful by patients and families, as well as staff.

Conclusion: Despite significant progress in PPC in South Korea, quantitative capacity remains limited. Further qualitative improvements in policies, practices, human resource development, and healthcare training are essential. This study provides insights into current PPC practices and their limitations. The development of practical evidence to enhance employment stability warrants further investigation.

As the demand for end-of-life care increases, the development of a well-structured training and certification system for palliative medicine specialists is becoming increasingly important. In South Korea, a certification system for palliative care physicians has been in place since 2019, managed by the Korean Society for Hospice and Palliative Care. To further develop this certification system and training process, this review aims to describe hospice and palliative medicine certification programs across eight countries/regions-the United States, the United Kingdom, Australia, Japan, Taiwan, Hong Kong, and South Korea-to identify key differences and draw insights for enhancing Korea's physician training and certification system. Most countries/regions recognize hospice and palliative medicine as medical subspecialty and provide standardized training and certification pathways. Training durations range from 1-year fellowships to multiyear structured programs with clinical experience. Japan's tiered certification system offers a flexible approach based on care settings and physicians' expertise. However, Korea's system lacks in-depth clinical experience and government recognition, limiting its sustainability. To strengthen palliative care in Korea, it is essential to enhance training duration, expand clinical exposure, and foster multispecialty collaboration. A tiered certification system adapted to Korea's healthcare environment and supported by government policy could improve both the quality and reach of palliative care services. These findings can inform future policy and educational reforms to ensure more effective and sustainable training of palliative care professionals in Korea.

Purpose: This study aimed to investigate the prescribing patterns of medications for chronic diseases in patients with terminal cancer in South Korea as their life expectancy declined.

Methods: This study analyzed data on cancer patients from the National Health Insurance Service (NHIS) database in South Korea. It included a total of 89,606 patients who died of cancer in 2021. We evaluated prescriptions for dyslipidemia, hypertension, diabetes, and osteoporosis at 52, 12, 4, and 1 week prior to death.

Results: A significant proportion of patients nearing death continued to receive prescriptions for chronic disease medications, despite guidelines suggesting that these medications can be discontinued when life expectancy is limited. For instance, 2.6% of patients were prescribed medications for dyslipidemia just 1 week before death, highlighting a discrepancy between clinical practice and recommended guidelines.

Conclusion: These findings underscore the need to reevaluate prescription practices for terminal cancer patients. Optimizing medication use can decrease polypharmacy, reduce adverse drug reactions, and increase the quality of life (QOL) for these individuals.

In 2018, the South Korean government launched a community care policy aimed at providing more extensive social services for older adults, the disabled, and mental health patients. This policy also included an expansion of home-based hospice services in response to the growing demand for hospice and palliative care. Despite these initiatives, social workers play a limited role in home-based hospice care, and those specializing in hospice and palliative care are not yet fully equipped to provide effective community care services. This study investigated both domestic and international research trends to identify key tasks for defining the roles of hospice and palliative care social workers within community care. It also examined how these social workers perceive community care. The findings suggest that previous research has called for a more precise definition of the roles of hospice and palliative care social workers. It is particularly critical to address the underutilization of social workers in home-based hospice care, which is essential for effective community care. The study also revealed that while hospice and palliative care workers recognize the necessity of community care, their understanding of the community resources needed for its implementation and their actual performance in delivering such care are lacking. Additionally, their appreciation of the importance of establishing discharge plans, which include home visits, assessments and improvements of the residential environment, and transportation arrangements, was found to be limited. They acknowledged the need to establish a community linkage system and develop an information system to effectively implement community care. To clearly establish the role of hospice and palliative care social workers in community care, several measures should be taken: First, the role and function of home-based hospice and palliative care workers need to be institutionally strengthened. Second, training focused on developing discharge plans for these social workers should be improved. Concurrently, priority in this training should be given to those workers who are at a higher risk of burnout. Third, the activation of regional hospice centers should be pursued to ensure a robust community linkage system and the implementation of a community information system.

Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration. Nutritional support must be tailored to prognosis, with aggressive interventions generally avoided during end-of-life care. Although exercise may help to maintain mobility and alleviate symptoms, its feasibility is often limited. Pharmacological interventions, including appetite stimulants and anti-cachexia agents, remain largely investigational, with insufficient evidence for routine use in palliative care. Future research should refine sarcopenia assessment methods and develop patient-centered interventions that align with palliative care principles, emphasizing quality of life and individualized needs.

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing, and the condition is associated with a high mortality rate. For patients with COPD, the reality of a life-limiting illness causing severe breathlessness is often daunting. Unlike cancer, the progression of COPD is less predictable, making its prognosis challenging for clinicians. Patients with COPD in the intensive care unit (ICU) present a unique set of challenges characterized by persistent respiratory distress, dependence on ventilator support, and complex medical needs. Therefore, palliative care is vital for ICU patients with COPD, as it offers a compassionate, patient-centered approach that emphasizes symptom relief, quality of life, and alignment of care with patient values. However, palliative care for these patients is extremely difficult in Korea. Discussion of end-of-life care for non-cancer patients is particularly difficult in Korean society. One reason for this is that hospice palliative care is perceived as termination of treatment by the public. Additionally, because Korean society has a Confucian cultural background, people are usually reluctant to discuss death. Moreover, lack of attention among medical professionals is another key factor that makes implementing palliative care difficult for patients with end-stage COPD. This review aimed to explore ways to provide a meaningful and dignified life for patients with COPD in the ICU by administering palliative care.