심폐소생술 금지 동의 후 호스피스 병동과 암병동에서 사망한 말기 암환자의 특성 비교
Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards
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Purpose: This was a descriptive study to compare the characteristics and outcomes among deceased cancer patients that had do-notattempt-resuscitation (DNAR) agreements in hospice and oncology wards. Methods: Subjects of this study were 250 patients with terminal cancer who died after making DNAR agreements from January 1, 2015 to December 31, 2016 . The subjects were divided into two groups those that died in hospice (n=150) and those that died in oncology wards (n=100). Data were collected from August 2017 to February 2018. Two trained investigators independently reviewed the medical records for subjects using survey tools developed by the researchers (r =.81). Results: Among the general characteristics between two groups, there were differences in age (t=-2.54, p=.012) and education (χ2=5.96, p=.015). Among the disease related characteristics, there were differences in surgery history (χ2=10.09, p=.001), chemotherapy history (χ2=11.08, p=.002) and symptoms (t=5.14, p<.001) between the two groups. Among the treatment related characteristics, there were differences in chemotherapy at death (χ2=9.61, p=.002), radiotherapy at death (χ2=5.60, p=.018) and cardiopulmonary resuscitation (χ2=6.15, p=.029) between the two groups. Among nursing related characteristics, there was a difference in the frequency of nursing intervention after DNAR consent (t=3.72, p<.001) between the two groups. Among outcomes related characteristics, there were differences in consciousness state at the DNAR consent (χ2=64.82, p<.001), self-written consent (χ2=18.26, p=.001), hospitalization days (t=2.31, p=.022) and the cost per day of hospitalization (t=-4.81, p<.001) between the two groups. Conclusion: This study found that the patients, families, and medical staff need to change their perception of hospice and palliative care to prevent medical expenses from rising due to unnecessary life-support treatment while preparing for death with family members.
Abstract
Purpose: This was a descriptive study to compare the characteristics and outcomes among deceased cancer patients that had do-notattempt-resuscitation (DNAR) agreements in hospice and oncology wards. Methods: Subjects of this study were 250 patients with terminal cancer who died after making DNAR agreements from January 1, 2015 to December 31, 2016 . The subjects were divided into two groups those that died in hospice (n=150) and those that died in oncology wards (n=100). Data were collected from August 2017 to February 2018. Two trained investigators independently reviewed the medical records for subjects using survey tools developed by the researchers (r =.81). Results: Among the general characteristics between two groups, there were differences in age (t=-2.54, p=.012) and education (χ2=5.96, p=.015). Among the disease related characteristics, there were differences in surgery history (χ2=10.09, p=.001), chemotherapy history (χ2=11.08, p=.002) and symptoms (t=5.14, p<.001) between the two groups. Among the treatment related characteristics, there were differences in chemotherapy at death (χ2=9.61, p=.002), radiotherapy at death (χ2=5.60, p=.018) and cardiopulmonary resuscitation (χ2=6.15, p=.029) between the two groups. Among nursing related characteristics, there was a difference in the frequency of nursing intervention after DNAR consent (t=3.72, p<.001) between the two groups. Among outcomes related characteristics, there were differences in consciousness state at the DNAR consent (χ2=64.82, p<.001), self-written consent (χ2=18.26, p=.001), hospitalization days (t=2.31, p=.022) and the cost per day of hospitalization (t=-4.81, p<.001) between the two groups. Conclusion: This study found that the patients, families, and medical staff need to change their perception of hospice and palliative care to prevent medical expenses from rising due to unnecessary life-support treatment while preparing for death with family members.
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