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Kim K, Park B, Gu B, Nam EJ, Kye SH, Choi JY. The National Hospice and Palliative Care registry in Korea. Epidemiol Health 2022; 44:e2022079. [PMID: 36177979 PMCID: PMC9943630 DOI: 10.4178/epih.e2022079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
The National Hospice and Palliative Care (NHPC) registry is a nationwide database in Korea that systematically collects information on terminally ill cancer patients receiving inpatient hospice care. From 2018 to 2020, a total of 47,911 patients were enrolled in the NHPC registry from hospitals providing inpatient hospice care. The NHPC database mainly contains the socio-demographic and clinical information of the registered patients. Among these patients, approximately 75% were 60 years or older, and the ratio of males to females was 1:1.41. Lung, liver, colorectal, pancreatic, and gastric cancer made up nearly 90% of the cancer sites among the registered patients. Upon their initial admission to the hospice ward, around 80% of the patients were aware of their terminal illness. About half of the patients had mild pain at the time of the initial admission to the hospice ward, and the duration of hospice care was 14 days (interquartile range, 6-30) in 2019 and 2020. The NHPC registry aims to provide national statistics on inpatient hospice care to assist health policy-making.
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Affiliation(s)
- Kyuwoong Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Bohyun Park
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Bonju Gu
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jeong Nam
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Sue Hyun Kye
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea,Correspondence: Jin Young Choi National Hospice Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea E-mail:
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Choi J, Kong K, Chang Y, Jho H, Ahn E, Choi S, Park S, Lee M. Effect of the duration of hospice and palliative care on the quality of dying and death in patients with terminal cancer: A nationwide multicentre study. Eur J Cancer Care (Engl) 2017; 27:e12771. [DOI: 10.1111/ecc.12771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 01/27/2023]
Affiliation(s)
- J.Y. Choi
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - K.A. Kong
- Department of Preventive Medicine; College of Medicine; Ewha Womans University; Seoul South Korea
| | - Y.J. Chang
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - H.J. Jho
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - E.M. Ahn
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - S.K. Choi
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - S. Park
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - M.K. Lee
- College of Nursing; Research Institute of Nursing Science; Kyungpook National University; Daegu South Korea
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Lee BS, Kwak SY. Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study. J Korean Acad Nurs 2017; 47:98-109. [DOI: 10.4040/jkan.2017.47.1.98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/18/2016] [Accepted: 12/02/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - Su Young Kwak
- Department of Nursing, Keimyung College University, Daegu, Korea
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An AR, Lee JK, Yun YH, Heo DS. Terminal cancer patients' and their primary caregivers' attitudes toward hospice/palliative care and their effects on actual utilization: A prospective cohort study. Palliat Med 2014; 28:976-985. [PMID: 24781817 DOI: 10.1177/0269216314531312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies on hospice/palliative care indicated that patients' socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated. AIM To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities. DESIGN A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient's death, caregivers were interviewed whether they utilized hospice/palliative care facilities. PARTICIPANTS A total of 359 patient-caregiver dyads completed baseline questionnaires. After the patients' death, 257 caregivers were interviewed. RESULTS At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16-3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20-3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver's preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53-4.67). No patient-related factors were associated with hospice/palliative care utilization. CONCLUSION Promoting awareness of prognosis and to improve communication between doctors and families is important for facilitating the use of hospice/palliative care.
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Affiliation(s)
- Ah Reum An
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - June-Koo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Yun
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Medicine, Seoul National University College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Ahn E, Shin DW, Choi JY, Kang J, Kim DK, Kim H, Lee E, Hwang KO, Oh B, Cho B. The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients. Psychooncology 2013; 22:2771-8. [PMID: 23839783 DOI: 10.1002/pon.3346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 11/07/2022]
Abstract
OBJECTS We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. METHODS Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. RESULTS Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p < 0.001), 'maintaining hope and pleasure' (4.55 vs. 3.92; p = 0.002), and 'unawareness of death' (4.41 vs. 4.26; p = 0.024). CONCLUSION Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged.
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Affiliation(s)
- Eunmi Ahn
- Department of Family Medicine, Family Medicine, Seoul National University Hospital, Seoul, Korea
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Choi JY, Chang YJ, Song HY, Jho HJ, Lee MK. Factors that affect quality of dying and death in terminal cancer patients on inpatient palliative care units: perspectives of bereaved family caregivers. J Pain Symptom Manage 2013; 45:735-45. [PMID: 23102560 DOI: 10.1016/j.jpainsymman.2012.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/27/2012] [Accepted: 04/02/2012] [Indexed: 11/18/2022]
Abstract
CONTEXT There is an increasing use of palliative care units (PCUs) for the treatment of terminally ill cancer patients. Thus, it is important to evaluate the care and quality of life of terminally ill cancer patients treated in PCUs so that improvements can be made. Limited research has investigated the quality of dying and death in PCUs. OBJECTIVES The aim of this study was to identify factors associated with the quality of dying and death for terminally ill cancer patients in PCUs. METHODS Data were collected from 570 bereaved family caregivers of terminally ill cancer patients. All patients were registered and died in one of the 40 inpatient PCUs designated by the Korean Ministry of Health and Welfare. We assessed the perceived timing of referral to a PCU; the quality of end-of-life cancer care with the Care Evaluation Scale; and the quality of dying and death with the Good Death Inventory. RESULTS The perception of appropriate timing of referral, use of a community-based PCU, and higher quality of cancer care as assessed by the Care Evaluation Scale were associated with good dying and death in all domains of the Good Death Inventory. CONCLUSION The good quality of end-of-life care in a PCU improves the quality of dying in terminally ill cancer patients. The data have the potential to guide the development of interventions aimed at achieving a good quality of dying for patients with terminal cancer.
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Affiliation(s)
- Jin Young Choi
- National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
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Kwak SY, Lee BS. Experience in Acceptance of Hospice by Patients with Terminal Cancer : A Phenomenological Research. J Korean Acad Nurs 2013; 43:781-90. [DOI: 10.4040/jkan.2013.43.6.781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Su Young Kwak
- Dongsan Medical Center, Keimyung University, Daegu, Korea
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Shin DW, Hwang SS, Oh J, Kim JH, Park JH, Cho J, Cho B, Jung KT, Park EC. Variations in pain management outcomes among palliative care centers and the impact of organizational factors. Cancer 2012; 118:5688-97. [PMID: 22570083 DOI: 10.1002/cncr.26722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 10/27/2011] [Accepted: 10/27/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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Song JI, Shin DW, Choi JY, Kang J, Baek YJ, Mo HN, Seo MJ, Hwang YH, Lim YK, Lee OK. Quality of life and mental health in the bereaved family members of patients with terminal cancer. Psychooncology 2011; 21:1158-66. [DOI: 10.1002/pon.2027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 12/22/2022]
Affiliation(s)
- Jong Im Song
- Department of Family Medicine; Kangwon National University Hospital; Korea
| | - Dong Wook Shin
- Department of Family Medicine and Health Promotion Center; Seoul National University Hospital; Korea
| | - Jin-Young Choi
- National Cancer Control Institute; National Cancer Center; Korea
| | - Jina Kang
- National Cancer Control Institute; National Cancer Center; Korea
| | - Young-Ji Baek
- National Cancer Control Institute; National Cancer Center; Korea
| | - Ha-Na Mo
- National Cancer Control Institute; National Cancer Center; Korea
| | - Min-Jeong Seo
- Gangnam St. Mary Hospital; The Catholic University of Korea; Korea
| | | | | | - Ok Kyoung Lee
- St. Vincent's Hospital; The Catholic University of Korea; Korea
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Shin DW, Choi JE, Kim JH, Joo JS, Choi JY, Kang J, Baek YJ, Mo HN, Park JH, Park EC. What is the best practical survey method for the comparative assessment of palliative care services: results from a national quality assessment project in Korea. J Pain Symptom Manage 2011; 42:251-64. [PMID: 21458215 DOI: 10.1016/j.jpainsymman.2010.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/28/2010] [Accepted: 11/06/2010] [Indexed: 11/30/2022]
Abstract
CONTEXT There is an increasing need for the comparative assessment of palliative care services; however, few systematic empirical studies have been performed to determine the most feasible, representative, efficient survey method. OBJECTIVES To investigate the feasibility, representativeness, and efficiency of several survey methods. METHODS This study was performed as a part of a national initiative to develop a system to evaluate the quality of palliative care services. Three separate but related surveys of patients, caregivers, and bereaved family members were conducted. These surveys were designed to simulate an independent assessment in a nationwide quality evaluation project. RESULTS The effective response rates for the patient, caregiver, and bereavement surveys were 30.4% (105 of 344), 46.5% (160 of 344), and 20.9% (501 of 2398), respectively. Subjects who responded to the patient and caregiver surveys were likely to have better physical and mental conditions, whereas subjects who responded to the bereaved family survey did not differ significantly from nonrespondents in regard to patient characteristics, except for a small difference in patient gender (females: 47.2% vs. 41.7%, P=0.028). The average number of responses per institution was 3.2, 4.8, and 15.2, respectively. The cost of the patient and caregiver surveys was much higher than the cost of the bereaved family member survey. CONCLUSION There were significant differences between the three methods. Despite the low response rate, our findings suggest that the bereaved family member survey has strengths in terms of feasibility and efficiency, and could be considered as a practical option for the comparative assessment of palliative care services by an independent body.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Baek YJ, Shin DW, Choi JY, Kang J, Mo HN, Kim YH, Kim S, Jung KW, Joo J, Park EC. Late referral to palliative care services in Korea. J Pain Symptom Manage 2011; 41:692-9. [PMID: 21232909 DOI: 10.1016/j.jpainsymman.2010.06.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 12/01/2022]
Abstract
CONTEXT Although timely referral to palliative care services can help improve quality of life by minimizing patient and family suffering during a life-threatening illness, it remains unclear whether patients in Korea who suffer from advanced cancer are referred to palliative care services in a timely manner. OBJECTIVES We aimed to investigate the timeliness of patient referral to palliative care services in Korea by examining the duration of survival after enrollment and identify the factors contributing to earlier or later referral. METHODS Patient- and episode-level data were collected from 3867 terminal cancer patients, who were registered in 34 inpatient palliative care services designated by the Ministry of Health, Welfare, and Family Affairs. Cox proportional hazard models were used to determine factors associated with the duration of survival after enrollment in palliative care services. RESULTS The median duration of survival after enrollment in palliative care services was 18 days. Male sex, liver cancer diagnosis, poor performance status, being covered by National Health Insurance, and being married were significantly associated with shorter duration of survival after enrollment, whereas a prostate cancer diagnosis was associated with longer survival. CONCLUSION Korean terminal cancer patients are referred to palliative care very late, and the timing appears to be influenced by some socioeconomic and medical factors. Interventions, such as physician education and establishing palliative care teams, are required to promote earlier referrals in Korea.
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Affiliation(s)
- Young Ji Baek
- National Cancer Control Institute, National Cancer Center, Seoul, Republic of Korea
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Choi JY, Shin DW, Kang J, Baek YJ, Mo HN, Nam BH, Seo WS, Park JH, Kim JH, Jung KT. Variations in process and outcome in inpatient palliative care services in Korea. Support Care Cancer 2011; 20:539-47. [PMID: 21347522 DOI: 10.1007/s00520-011-1115-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 02/02/2011] [Indexed: 11/30/2022]
Abstract
PURPOSES Hospice programs in Korea have been largely based on volunteer activity, religious services, or social services. Recent government policy of designating medically based inpatient palliative care services and per diem payment system made it necessary to monitor the quality of these services. We examined the variation in the process and outcomes of palliative care services, using 2009 data obtained from the Korean Terminal Cancer Patient Information System. METHODS Data were collected from 3,867 patients with terminal cancer who were registered in 34 inpatient palliative care centers designated by the Ministry of Health and Welfare. We used the mean length of stay and the subsequent place of care as process indicators, and change in average pain score as an outcome indicator. The data were analyzed using descriptive statistics, and analysis of covariance for the case-mix adjustment. RESULTS There were considerable variations among services with regards to the mean length of stay (i.e., 10.5 to 32.6 days for each admission) and subsequent place of care (i.e., 39.8% to 92.6% ended in death at the first admission), even after stratification by service level. The mean change in average pain score varied from -1.48 to 2.16, and remained significant after case-mix adjustment. CONCLUSION We found considerable variations among palliative care services with regard to the mean length of stay, subsequent place of care, and change in average pain score. Continued assessment of the variations in process and outcomes will assist in developing the national benchmarking system and the evaluation of the government policy.
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Affiliation(s)
- Jin Young Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi, South Korea
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