The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Clinical considerations about terminally ill cancer patients who died in hospice unit

호스피스 병동에서 임종한 말기암 환자의 임상적 고찰

Moon, Do-Ho;Choe, Wha-Sook;Lee, Myung-Ah;Woo, In-Sook;Kang, Jin-Hyoung;Hong, Young-Seon;Lee, Kyung-Shick
문도호;최화숙;이명아;우인숙;강진형;홍영선;이경식

  • Published : 20040000
⟨ Previous Next ⟩

Abstract

Background : Although physicians state that patients ideally should receive hospice palliative care for 3 months before death, the majority of patients survive less than one month in hospice palliative care. This is too short to do effective hospice palliative care. Therefore, we figured out the problems through the clinical considerations about terminally ill cancer patients who had died in hospice unit. Methods: From July to December in 2003, 107 patients with terminally ill cancer who had died in Sam Anyang Hospice Unit were enrolled in this study. For getting the informations about patients characteristics, we reviewed the medical records and interviewed the patients on the first visit. Results: There were 70 males (65%) and 37 females (35%), and median age of patients was 60 years (range 23-93). The most common cancer was stomach cancer (18 patients, 17%). Forty seven patients (44%) took analgesics, the others 60 (56%) not. The most common symptom was pain (75 patients, 70%) and the most prevalent reason for admission was also pain (60, 56%). The most prevalent physician specialty who transferred patients or referred to local hospital was other internal medicine (48 patients, 44%), followed by hemato-oncology (38, 36%), surgery (12, 11%) and others (9, 9%). The median duration between the day when the patients were diagnosed as terminally ill cancer patient and the day when they were referred to hospice center is 48 days. The median survival in hospice palliative care is 30 days. The median hospitalization is 19 days. Conclusion: We found that lack of recognition about hospice palliative care of physicians, patients and families made the length of hospice palliative care too short. To do effective hospice palliative care, it needs education and promotion for them constantly.

목적 : 의사들은 효과적인 호스피스 완화의료를 위해서는 적어도 임종 3개월 전에 호스피스 완화의료에 의뢰되는 것이 바람직하다고 말하나 대부분의 호스피스.완화의료 환자는 임종 전 1개월 이내의 짧은 기간동안 돌봄을 받고 있는 것으로 보고되고 있다. 따라서 효과적인 호스피스 완화의료를 위해서 호스피스 병동에서 임종한 말기암 환자의 임상적 고찰을 통하여 문제점을 알아보고자 하였다. 방법 : 2003년 7월 1일에서 12월까지 샘 안양 병원 호스피스 병동에서 임종한 말기 암 환자 107명의 환자를 대상하였다. 환자의 특성에 대한 정보를 얻기 위하여 첫 방문 때에 면담을 하고 의무기록을 조사하였다. 결과 : 대상자 중 남자는 70명(65%), 여자 37명(35%) 이며 연령의 중간값이 60세(범위 23-93세)였다 가장 많 은 암은 위암으로 18명(17%)이였다. 진통제를 복용하고 있었던 환자는 47명(44%)였으며 그렇지 않은 환자는 60 명(56%)였다. 가장 흔한 증상은 통증으로 75명(70%)이 호소하였으며 가장 많은 입원 이유 또한 통증으로 60명 (56%)이였다. 가장 많은 전원 혹은 전과의사는 일반내과로 48명(44%)이였으며 종양내과가 38명<36%), 외과 12명(11%), 기타 9명(9%)이였다. 말기 진단 후 호스피스 완화의료를 받기까지 기간의 중간값은 48일이였다. 호스피스 완화의료 동안의 생존기간의 중간값은 30일이였으며 입원 일수의 중간값은 19일이였다. 결론 : 의사와 환자, 가족의 호스피스 완화의료에 대 한 인식 부족으로 호스피스 완화의료의 기간이 너무 짧았으며 효과적인 호스피스 완화의료를 위해서는 지속적인 교육과 홍보가 필요하다고 생각된다.

Keywords

References

  1. 보건사회부. 한국인 암 등록 조사자료 보고서. 2000.
  2. Hadorn DC. The Oregon priority-setting exercise: quality of life and public policy. Hastings Cent Rep 21:S11-S16, 1991. https://doi.org/10.2307/3562904
  3. 유상연, 염창완, 이혜리, 이용제, 안미홍. 호스피스 케어를 위해 입원한 말기 암 환자의 사망직전 의료비용 실태조사. 한국호스피스완화의료학회지 2:146-154, 2002.
  4. Lamont EB, Christakis NA. Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer 94.'2733-2737, 2002.
  5. Christakis NA, Iwashyna TJ. The impact of individual and market factors on the timing of initiation of hospice terminal care. Med Care 38:528-541, 2000. https://doi.org/10.1097/00005650-200005000-00009
  6. Christakis NA, Escarce JJ. Survival of medicare patients after enrollment in hospice programs. N Engl J Med 335:172~178, 1996.
  7. Christakis NA, Lamont EB. Extent and determinants of error in doctors' prognosis for terminal patients: prospective cohort study. EMJ 320:469-472, 2000.
  8. Morris JN, Suissa S, Sherwood S, Wright K, Greer DS. Last days: a study of the quality of life of terminally ill cancer patients. J Chronic Dis 39:47-62, 1986. https://doi.org/10.1016/0021-9681(86)90106-2
  9. 윤영호, 김철환. 암성통증관리에 관한 전공의들의 지식 및 태도. 대한가정의학회지 18:591-600, 1997.
  10. von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management. Ann Intern Med 119:121-126, 1993. https://doi.org/10.7326/0003-4819-119-2-199307150-00005
  11. Larue F, Colleau SM, Fontaine A, Brasseur L. Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France. Cancer 76:2375-2382, 1995. https://doi.org/10.1002/1097-0142(19951201)76:11<2375::AID-CNCR2820761129>3.0.CO;2-C
  12. Weissman DE. Cancer pain education for physician for physicians in practice: establishing a new paradigm J Pain Symtom Manage 12:364-371, 1996. https://doi.org/10.1016/S0885-3924(96)00185-6
  13. 윤영호, 허대석, 김홍수, 오상우, 유태우, 김유영, 허봉렬. 말기암 환자의 통증 및 통증관리에 영향을 미치는 요인. 한국호스피스완화의료학회지 1:23-29, 1998.
  14. Yun YH, Lee CG, Kim SY, Lee SW, Heo DS, Kim JS, Lee KS, Hong YS, Lee JS, You CH. The attitudes of cancer patients and their families toward the disclosure of terminal illness. J Clin Oncol 22:307-314, 2004. https://doi.org/10.1200/JCO.2004.07.053
  15. Greer DS, Mar V, Morris JN, Sherwood S, Kidder D, Brinbaum H. Alternative in terminal care: results of the national hospice study. J Chronic Dis 39:9-26, 1986. https://doi.org/10.1016/0021-9681(86)90103-7