암환자와 가족 입장에서 본 호스피스·완화의료 제도화

Abstract

Background : Many terminal cancer patients and families are affected with physical, emotional, and social problems. Many people claim that a type of medical services is needed to manage them such as hospice·palliative care. There have not been many studies of cancer patients and families with respect to their opinions and attitudes on hospice·palliative care for terminal cancer patients, although their views on it is important.

Methods : We surveyed 687 in-patients, out-patients and their families with cancer in 8 hospitals. The self-administered questionnaires included the following; 1) socio-demographic and clinical variables; 2) opinions on hospice·palliative care; 3) attitudes on ethical issues associated with hospice·palliative care; 4) factors associated with withholding futile care at the end-of-life. The data were analyzed with x2-test, Mantel-Haenszel x2-test, and multiple logistic regression.

Results : Almost 90% of the subjects agreed to the need of obtaining hospice·palliative care with health care insurances and reaching a social consensus on the contents of its programs. Five hundred and seventy six (83.8%) subjects agreed to the need of using advanced directives. Two hundred and eighty five (72.2%) cancer patients and 200 (68.5%) families agreed to the need of withholding futile care at the end-of-life and of people accepting their cancer diagnosis with insight and living in the metropolis as they were more likely to do. In the multivariate analysis, the attitudes on withholding futile care at the end-of-life was significantly different only by insight of cancer diagnosis (OR; 1.09∼3.15).

Conclusion : This study showed that hospice·palliative care should be established through social consensus on the issues related to ethics and insurances, and that cancer patients and families must have a right to choose such services with informed decision-making.