Shin, Jinyoung
(Department of Family Medicine, Konkuk University School of Medicine)
,
Chang, Yoon Jung
(National Hospice Center, National Cancer Center)
,
Park, So-Jung
(National Hospice Center, National Cancer Center)
,
Choi, Jin Young
(National Hospice Center, National Cancer Center)
,
Kim, Sun-Hyun
(Department of Family Medicine, International St. Mary's Hospital College of Medicine, Catholic Kwandong University)
,
Choi, Youn Seon
(Department of Family Medicine, Korea University Guro Hospital)
,
Kim, Nam Hee
(Maumtodac Psychiatric Clinic)
,
Yum, Ho-Kee
(Department of Internal Medicine, Seoul Paik Hospital, Inje University)
,
Nam, Eun Mi
(Department of Internal Medicine, Ewha Womans University College of Medicine)
,
Park, Myung Hee
(Hospice & Palliative Care Unit, The Catholic University of Korea, Seoul St. Mary's Hospital)
,
Moon, Nayeon
(Department of Family Medicine, VHS Medical Center)
,
Moon, Jee Youn
(Department of Anesthesiology and Pain Medicine, Seoul National University School of Medicine)
,
Kang, Hee-Taik
(Department of Family Medicine, Chungbuk National University College of Medicine)
,
Kang, Jung Hun
(Department of Internal Medicine, Gyeongsang National University College of Medicine)
,
Park, Jae-Min
(Departmen)
,
Lee, Chung-Woo
,
Kim, Seon-Young
,
Lee, Eun Jeong
,
Koh, Su-Jin
,
Kim, Yonghwan
,
Cho, Myongjin Agnes
,
Song, Youhyun
,
Shim, Jae Yong
A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical an...
A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.
A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.
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제안 방법
After explaining to the patient and his or her family members the advantages and disadvantages of providing IV fluids and nutrition and the fact that there are no conclusive results on whether the dying process is shortened if IV fluids and nutrition are not given, the patient’s comorbidities, cultural viewpoints, religion, level of consciousness, physical condition, level of thirst, and risk of pulmonary edema should be considered before making a decision.
The definition is not limited to the definition used in the Act on Decisions on Life-Sustaining Treatment and reflects medical professionals’ clinical judgement. The aim of this guideline is to help patients in the dying process and their family members to prepare for death, to manage physical and psychological symptoms in the dying process, and to increase quality of life and improve satisfaction among patients and family members by providing psychological support and adequate decision-making so they can prepare for a peaceful death. A limitation is that research on patients in the dying process is lacking, especially large-scale studies that are well-designed, but this guideline was developed by adapting 14 existing clinical practice guidelines both locally and globally [1-14].
대상 데이터
This review introduces 28 recommendations, and the full document can be viewed at the clinical practice guideline information center (https://www.guideline.or.kr/guide/view. php?number=1108&cate=A).
참고문헌 (15)
1 National Institute for Health and Care Excellence 2015 Care of dying adults in the last days of life [Internet] Care of dying adults in the last days of life (NICE) Available from: https://www.nice.org.uk/guidance/ng31 . cited 2018 Apr 17
2 Registered Nurses’ Association of Ontario 2011 End-of-life care during the last days and hours Registered Nurses’ Association of Ontario Toronto, Ont.
3 National Consensus Project for Quality Palliative Care c2013 Clinical practice guidelines for quality palliative care 3rd ed National Consensus Project for Quality Palliative Care Pittsburgh
4 American Society of Clinical Oncology 2017 Patient-clinician communication American Society of Clinical Oncology (ASCO) Alexandria, VA
5 Korean Society of Critical Care Medicine 2018 Korean professional consensus for comfort care and withdrawing/withholding in the intensive care unit Korean Society of Critical Care Medicine (KSCCM) Seoul
6 Agency for Healthcare Research and Quality 2013 Palliative care for adults Agency for Healthcare Research and Quality (AHRQ) Agency for Rockville, MD
7 Societe quebecoise des medecins de soins palliatifs (SQMSP) and the College des medecins du Quebec 2016 Palliative sedation at the end of life College des medecins du Quebec (CMQ) Montreal, Quebec
8 Australian Commission on Safety and Quality in Health Care 2015 Essential elements for safe and high-quality end-of-life care ACSQHC Sydney
9 Druml C Ballmer PE Druml W Oehmichen F Shenkin A Singer P 2016 ESPEN guideline on ethical aspects of artificial nutrition and hydration Clin Nutr 35 545 56 10.1016/j.clnu.2016.07.001 26923519
10 McClave SA DiBaise JK Mullin GE Martindale RG 2016 ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient Am J Gastroenterol 111 315 34 26952578
11 Canadian Coalition for Seniors’ Mental Health 2014 The assessment and treatment of delirium Canadian Coalition for Seniors’ Mental Health Toronto, ON
12 Cherny NI ESMO Guidelines Working Group 2014 ESMO clinical practice guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation Ann Oncol 25 Suppl 3 iii143 52 25210083
13 National Comprehensive Cancer Network 2018 NCCN clinical practice guidelines in oncology. Palliative care, Version 1 National Comprehensive Cancer Network Fort Washington, PA
14 Howard LS Earis J Mak V O’Driscoll BR 2017 British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings BMJ Open Respir Res 4 e000170
15 Maltoni M Scarpi E Rosati M Derni S Fabbri L Martini F 2012 Palliative sedation in end-of-life care and survival: a systematic review J Clin Oncol 30 1378 83 22412129
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