Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea.
Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
J Korean Med Sci. 2018 Sep 10;33(41):e263. doi: 10.3346/jkms.2018.33.e263. eCollection 2018 Oct 8.
Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT).
We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU.
The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was "refusing hospice facility" (34.9%), followed by "near death," "poor accessibility to an HPCU," and "caregiving problems."
Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.
在过去十年中，建立和指定专门的临终关怀姑息治疗单位（HPCU）一直是韩国国家政策促进临终关怀姑息治疗的重要组成部分。然而，很少有研究试图确定在国家政策实施期间利用 HPCU 的模式和障碍。我们旨在调查与姑息治疗团队（PCT）咨询后利用 HPCU 治疗终末期癌症患者相关的因素。
我们回顾了 2010 年和 2014 年转诊至国家癌症中心 PCT 的 1028 例终末期癌症患者的病历。我们比较了决定利用 HPCU 的患者和未决定利用 HPCU 的患者的特征。我们还分析了影响医疗机构选择的因素以及不选择 HPCU 的原因。
患者的平均年龄为 61.0 ± 12.2 岁，肺癌患者（24.3%）占这些患者的最大比例。2014 年转诊患者中有 53.9%利用了 HPCU，高于 2010 年的 44.6%。年龄较大和对终末期疾病的认识与利用 HPCU 呈正相关。不选择 HPCU 的最常见原因是“拒绝临终关怀设施”（34.9%），其次是“接近死亡”、“难以获得 HPCU”和“护理问题”。
与 2010 年相比，2014 年终末期癌症患者利用 HPCU 的比例有所增加。提高患者和家属对终末期状况的认识，以及更早地讨论临终关怀，对于促进 HPCU 的利用将是重要的。
