초록 ▼

본 연구는 지역사회 기반 재가 만성질환자의 생의 말기 돌봄서비스 모델을 개발 및 적용하여 그 효과를 평가하기 위함이며, 이를 통해 환자 및 가족의 삶의 질을 높이고자 실시되었음.

1차년도에 기초 요구도 조사 및 자문가 회의를 통해 재가 만성질환자를 위한 생의 말기 돌봄서비스 모델 개발을 개발하였고, 2차년도에는 모델의 현장적용성 검증을 통해 개발된 모델을 보완하였음. 3차년도에는 생의 말기 돌봄서비스 모델의 효과를 실험군 32명, 대조군 32명을 대상으로 평가하였음. 이 결과를 통해 실험군에서 가족의 삶의 질, 가족의

본 연구는 지역사회 기반 재가 만성질환자의 생의 말기 돌봄서비스 모델을 개발 및 적용하여 그 효과를 평가하기 위함이며, 이를 통해 환자 및 가족의 삶의 질을 높이고자 실시되었음.

1차년도에 기초 요구도 조사 및 자문가 회의를 통해 재가 만성질환자를 위한 생의 말기 돌봄서비스 모델 개발을 개발하였고, 2차년도에는 모델의 현장적용성 검증을 통해 개발된 모델을 보완하였음. 3차년도에는 생의 말기 돌봄서비스 모델의 효과를 실험군 32명, 대조군 32명을 대상으로 평가하였음. 이 결과를 통해 실험군에서 가족의 삶의 질, 가족의 돌봄 부담감 영역 중 정서적 영역에서 대조군보다 통계적으로 유의한 차이를 보였음. 서비스 만족도는 총 5점 만점에 4.48점으로 나타남.

또한 비용-편익 분석을 통해 가정돌봄서비스센터를 이용하는 경우 가정간호센터/방문간호사업소보다 순 편익이 6,654,562원이 발생하며, 비용에 비하여 편익이 2.10배 높다고 나타났음.

본 연구결과를 통하여 생의 말기 돌봄서비스는 지역사회 환자 및 그 가족이 생의 말기까지 질좋은 서비스를 받을 수 있도록 지원하며, 고령화와 더불어 급증하고 있는 재가 만성질환자들의 삶의 질 향상을 도모할 것임.

(출처 : 요약서 3p)

Abstract ▼

Purpose&Contents
This study aims to develop and implement the home-based end-of-life care service model for chronic patients under home-based care and evaluate its effectiveness. The findings of this study will inform a community-based, comprehensive, and systematic end-of-life care service model

Purpose&Contents
This study aims to develop and implement the home-based end-of-life care service model for chronic patients under home-based care and evaluate its effectiveness. The findings of this study will inform a community-based, comprehensive, and systematic end-of-life care service model that enhances the quality of life for patients and their family.

Year 1
○ Developed an end-of-life care service model for chronic patients under home-based care
- Surveyed the demand for an end-of-life care service among chronic patients under home-based care
- Surveyed the demand for an end-of-life care service among families of chronic patients under home-based care
- Explored prediction methods for end-of-life phases of chronic patients under home-based care

Year 2
○ Validated the feasibility of the home-based end-of-life care service model for chronic patients under home-based care
- Developed an end-of-life care service model (benchmarked from Japanese case studies)
- Developed a standard guideline
- Educated and trained service providers (medical staff)

Year 3
○ Implemented the home-based end-of-life care service model for chronic patients and evaluated its effectiveness
- Implemented the end-of-life care service model for chronic patients in a local community
- Evaluated the effectiveness of the model (comparison of changes before and after service provision)
- Explored ways to expand the community-based end-of-life care service model and bring it on stable footing within the established healthcare system

Results
Year 1
○ We finished a basic survey of the current state of affairs as the first step toward the development of an end-of-life care service for chronic patients under home-based care. Based on the survey findings and experts’ opinions, we proposed a framework for model development.

□ Retrospective study
- We selected 115 of the patients who satisfy the below criteria to survey their demand for a care service for each end-of-life phase (stable and terminal phases) by analyzing the patients’medical records and surveying nurses.
- Inclusion criteria
(1) 40 years old or above
(2) Diagnosed with non-cancer diseases
(3) Passed away during home-based nursing care

□ Prospective study
- We surveyed the demand for an end-of-life care service among 230 chronic patients under home-based care and 181 family members providing care for them (411 in total) in Seoul and northern and southern parts of Gyeonggi Province.

□ Qualitative study
- We had an in-depth interview with nine bereaved family members who recently provided home-based care to chronic patients for one year or longer. The interviewees shared with us their experiences with end-of-life care and their perception of an end-of-life situation.

□ Cohort study
- We formed a cohort of 133 chronic patients with the Palliative Prognostic Scale (PPS) of 40% or less. Their physiological markers and physical and mental predictors were measured, and survival analysis was performed on the patients’ mortality after six months.

Year 2
○ Developed guidelines on the end-of-life care service
- We developed four types of guidelines, each for medical practitioners, nurses, case managers, and voluntary workers, on comprehensive end-of-life care service for chronic patients under home-based care.

○ Recruited, educated, and trained service providers
- We recruited a group of service providers based in one local community, comprising three medical practitioners, five nurses, five case managers, and 11 voluntary workers, and provided them with education and training on the end-of-life care service tailored to their respective job description.

○ Validated the feasibility of the end-of-life care service model
- We recruited six patients and asked the group of service providers (medical practitioners, nurses, case managers, and voluntary workers) to implement the care service guidelines on the patients.
- We identified problems and room for development during model implementation, validated the feasibility of the program, and modified the model.

○ Built a website of a home-based care service center for non-cancer terminal patients
- The service provider group in this study will support the operation of home-based care service centers for non-cancer terminal patients at the local community level while educating and training other medical staff and voluntary workers. Going forward, we envision infrastructure for end-of-life care service at the local community level, where patients and their family members have access to information on participating clinics and care providers.

○ Two presentations at international academic conferences
- “Assessment of Care Needs for End of Life Among Home care Non-Cancer Patients in South Korea”. Greater than the Sum of Its Parts, 12th Asia Pacific Hospice Conference, July 28–29, 2017, Singapore.
- “Care Needs by End-of-Life Stage Among Non-Cancer Patients at Home”. The International Association of Gerontology and Geriatrics 21th World Congress, July 23–27, 2017, San Francisco.

○ Presentation at a domestic academic conference
- Home-based care for chronic patients: the current picture and future prospect. 2016 1st Semi-Annual Conference of the Korean Academic Society of Home Care Nursing, August 27, 2016, Chung-Ang University, Korea.

Year 3
○ Recruited, educated, and trained service providers
- We recruited groups of care service providers, each consisting of nine medical practitioners, 15 nurses, 10 case managers, and eight voluntary workers, for each local community and provided them with education and training sessions on end-of-life care service tailored to their job description.
○ Implemented the end-of-life care service model on patients under home-based care in each local community and evaluated its effectiveness
- We recruited 48 patients for the experiment group and 55 for the control group, of which 32 was chosen for each group for the study after screening. The care provider groups (medical practitioners, nurses, case managers, and voluntary workers) implemented the care service model developed in this study on the patient groups.
- We identified problems and room for development during model implementation, validated the feasibility of the program on a wider scale, and modified the model.
○ Analyzed the cost benefit analysis of the end-of-life care service model
○ Explored ways to expand the community-based end-of-life care service model and bring it on stable footing within the established healthcare system
- Applied the customer acquisition model
- Explored practical measures to implement and scale up the home-based care model
- Presented proposals on applying the care service model at a wider level and bringing it on stable footing

○ Journal publication
- Care Needs of Patients at the End of Life with a Non-Cancer Diagnosis Who Live at Home’ Journal of Nursing Research. Journal of Nursing Research. (Accepted on 27 Dec 2017. Publishing in progress). Lee Ji-won (first author) and Lee Jong-eun (corresponding author).

○ Presentation at an international academic conference
- “Predicting one-year survival in patients with an end-stage, non-cancer, chronic disease”. 5th Annual Public Health Conference, July 15-17, 2018, Bangkok, Thailand.

Expected Contribution
○ This study developed a community-based end-of-life care service model tailored to the demand of patients and their family. Going forward, this model will allow patients with chronic conditions to enjoy their last moments with their loved ones until their demise, thereby enhancing their quality of life; the family members who look after the chronic patients will also be able to perceive the end-of-life process from a more positive perspective while feeling less burdened about patient care.

○ Our end-of-life care service model provides a standardized guideline on the end-of-life care service. It can be implemented and scaled up for patients preparing for their death while under home-based care at local community levels.

○ Our model is community-based. Existing healthcare resources, including local clinics and visiting nursing service centers, can be deployed to implement the model, making it a cost-effective solution to home-based nursing care.

○ The model is consistent with the Korean government’s recent bid to promote community care. It will facilitate the expansion of social services for care provision and the reinforcement of a community-driven healthcare system.

○ The program proposed in this study will not only contribute to a better quality of life ofr an increasing number of home-based chronic patients, the trend driven by population aging, but also improve the healthcare system and facilitate the national policy objective of reducing social costs by filing the gap in healthcare service provision.

(출처 : SUMMARY 7p)

목차 Contents

• 표지 ... 1
• 제출문 ... 2
• 보고서 요약서 ... 3
• 국문 요약문 ... 4
• SUMMARY ... 7
• Contents ... 10
• 목차 ... 11
• 1. 연구개발과제의 개요 ... 12
• 가. 연구개발 목적 ... 12
• 나. 연구개발의 필요성 ... 12
• 다. 연구개발 범위 ... 14
• 2. 국내외 기술개발 현황 ... 15
• 3. 연구수행 내용 및 결과 ... 16
• 가. 1차년도 ... 16
• 나. 2차년도 ... 56
• 다. 3차년도 ... 66
• 라. 연차별 연구성과 ... 93
• 4. 목표달성도 및 관련분야 기여도 ... 94
• 가. 목표달성도 ... 94
• 나. 관련분야 기여도 ... 95
• 5. 연구결과의 활용계획 ... 96
• 6. 연구개발성과의 보안등급 ... 97
• 7. 연구개발과제의 대표적 연구실적 ... 97
• 8. 참고문헌 ... 98
• 별첨: 실적 증빙자료 ... 99
• 끝페이지 ... 127