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Journal of the Korean Academy of Family Medicine 2000;21(4):489-497.
Published online April 1, 2000.
Attitude of cancer patients, their primary care givers and doctors toward end-of-life care.
Jae Yong Shim, Youn Seon Choi, Yong Joon Kang, Hyun Sang Cho, Hang Suk Cho
1Department of Family Medicine, Yonsei University College of Medicine, Koera.
2Department of Family Medicine, Korea University College of Medicine, Koera.
3Department of Family Medicine, Dongshin Hospital, Korea.
4Department of Pediatrics, Hallym University College of Medicine, Korea.
5Department of Family Medicine, Kwandong University College of Medicine, Koera.
임종기 치료에 대한 암 환자 , 보호자 , 그리고 의사의 수용태도
최윤선, 심재용, 강용준, 조현상, 조항석
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Abstract
Background
: Decision about life sustaining treatments ought to be based on the patient’s in formed preferences. This study was to see if there were any differences in acceptance by patients, their primary care givers and doctors for end-of-life care according to situations, and if any, to analyse the factors related with different attitudes.

Methods : A structured questionnaire survey of end-of-life care preferences was performed on 162 cancer patients and their primary care givers in four university hospitals and one general hospital from March 1, 1999 to February 29, 2000. A similar survey was done for doctors practicing at the above, hospitals during the same period to investigate their attitudes toward providing end-of-life care to an assumed nearly bed ridden patients. ANOVA, t-test and Wilcoxon rank sum test were used to compare acceptance of intervention among the groups or according to the various situations. Factors presumed to be related to the acceptance were sought and analysed by stepwise multiple regression.

Results : The difference in acceptance of intervention between the primary care giver group and the doctor group was not significant in almost every situation, showing significantly higher than the patient group(P=0.001). All three groups showed higher acceptance when a therapeutic intervention rather than a diagnostic test was proposed(P=0.001). When expected survival was 30 days rather than 7 (P=0.01), and when the therapeutic intervention was thought as non-invasive rather than invasive (P=0.001). The less anxious the patient was , the higher the acceptance. From the patient. Patients with a religion had higher acceptance rate than non-religious patients. Primary care givers who expected sure of the disease accepted more of the postulated care than those who did not (P<0.05). Wives of mother-in-laws of patients showed lower acceptance than those in other relationship(P<0.05). The longer the patient had been diagnosed with cancer, the higher the acceptance of the primary care giver (P<0.1). Direct relatives showed higher acceptance than that of collaterals(P<0.01). Family doctors specializing in family medicine had lower acceptance than doctors of other specialties and interns(P<0.05)

Conclusion : The acceptance of intervention by patients was lower than that of primary care givers and doctors and depended on the expected survival and the type, of intervention.
초록
연구배경 : 검사나 치료를 선택할 때 환자의 의견이 반영되어야 한다. 암 환자의 임종기에 동반된 질환의 검사나 치료에 대한 환자, 환자의 보호자, 의사의 태도가 상황에 따라 차이가 있는지를 알아보고 관계 있는 요인을 분석하였다.

방법 : 1999년 3월 1일부터 2000년 2월 29일까지 4개 대학병원과 1개 종합병원에서 162명의 암 환자와 그의 치료에 책임이 있는 보호자에게 말기암 때 검사나 치료를 받은지를 묻는 구조화된 설문 조사를 하였다. 같은 기간에 동 병원에 근무하는 가정의학과, 단과 전문과, 인턴 등 104명의 의사에게 병상에 누워있는 말기암 환자를 가정하여 검사나 치료를 시행할지를 묻는 구조화된 설문 조사를 하였다. 여러 가지 질병상황을 가정하여 예상수명이 일주일 때와 한 달일 때의 수용도를 조사하여, 집단간 및 상황에 따른 차이를 분산분석, 티이 검정, 윌콕슨 순위합 검정으로 비교하였다. 수용도와 관계 있을 것으로 생각되는 요인들을 조사하여 단계별 다중회귀분석을 시행하였다.

결과 : 거의 모든 상황에서 보호자군과 의사군의 수용도는 유의한 차이가 없었으며 두 군은 환자군보다 유의하게 매우 높은 수용도를 나타내었다(P<0.001), 모든군에서 치료의 경우가 검사의 경우보다(P<0.001), 예상수명이 30일일 때가 7일일 때보다(P<0.01), 비관혈적 치료의 경우가 관혈적 치료의 경우보다 중재에 대한 수용도가 유의하게 높았다(P<0.001), 환자군에서는 불안할수록, 종교가 없는 사람에서 수용도가 낮았으며, 보호자 군에서는 완치 가능성에 대한 기대가 없는 사람에서 낮았고, 환자의 배우자나 며느리가 다른 관계의 보호자보다 수용도가 낮았다(P<0.05), 또한 암 진단 시점이 오래 되었을수록 보호자의 수용도가 높았다(P<0.01), 의사군에서는 단과 전문과목을 전공한 의사나 인턴이 가정의학과 의사보다 수용도가 높았다(P<0.05)

결론 : 임종기 상황에서 검사나 치료에 대한 암 환자의 수용도는 보호자나 의사의 수용도보다 낮으며 상황에 따라 차이를 보인다.


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