Su-Jin Koh

Validation of the Edmonton Symptom Assessment System in Korean Patients With Cancer

CONTEXT The Edmonton Symptom Assessment System (ESAS) is a brief, widely adopted, multidimensional questionnaire to evaluate patient-reported symptoms. OBJECTIVES To develop a Korean version of the ESAS (K-ESAS) and to perform a psychometric analysis in Korean patients with advanced cancer. METHODS We tested the K-ESAS in two pilot studies with 15 patients each. We assessed internal consistency, test-retest reliability, and concurrent validity in 163 Korean patients, who completed the K-ESAS along with the Korean versions of the M. D. Anderson Symptom Inventory (K-MDASI) and the Hospital Anxiety and Depression Scale (K-HADS) twice. A total of 38 patients completed the questionnaires again seven days later to assess responsiveness. RESULTS The K-ESAS scores had good internal consistency, with a Cronbachs alpha coefficient of 0.88, indicating that no questions had undue influence on the score. Pearson correlation coefficients for K-ESAS symptom scores between baseline and after two to four hours ranged from 0.72 (95% CI 0.64-0.79) to 0.87 (95% CI 0.82-0.90), indicating strong test-retest reliability. For concurrent validity, Pearson correlation coefficients between K-ESAS symptom scores and corresponding K-MDASI symptom scores ranged from 0.70 (95% CI 0.62-0.77) to 0.83 (95% CI 0.77-0.87), indicating good concurrent validity. For the K-HADS, concurrent validity was good for anxiety (r=0.73, 95% CI 0.65-0.79) but moderate for depression (r=0.4, 95% CI 0.26-0.52). For responsiveness, changes in K-ESAS scores after seven days were moderately correlated with changes in K-MDASI scores but weakly correlated with changes in K-HADS scores. CONCLUSION The K-ESAS is a valid and reliable tool for measuring multidimensional symptoms in Korean patients with cancer.

Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives

Purpose The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. Materials and Methods A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses. Results A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of “terminal state,” and mostrespondents tried to disclose the patient’s condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. Conclusion This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.

Surrogate decision making of chemotherapy consent: do we really provide informed consent of chemotherapy for patients?

Background/Aims Despite increased demand for cancer patient’s to make their own decisions based on an adequate understanding of what is involved in chemotherapy, the primary signing agent and the reasons for surrogate signing have not been appropriately evaluated. Methods The ethics committee of the palliative medicine subgroup of the Korean Cancer Study Group designed this study and solid cancer patients to whom chemotherapy was offered, from seven institutions, were evaluated. The details relating to surrogate’s signing of chemotherapy consent were evaluated. Then, we analyzed the factors associated with surrogate’s signing according to patient’s demographics and characteristics related to chemotherapy consent. Results Surrogate’s signing was noted for 20.7% (84/405) of patient and over half of surrogate signings were performed by the patients’ son or daughter (60.7%). Two main reasons for surrogate signing were patient’s incapacity (34.5%) and taking over authorization from patients (33.3%). The factors associated with more frequent surrogate’s signing were absence of spouse, lower education level, outpatient, and when residents played a role as a principle provider of chemotherapy consent. Conclusions This study suggests the lack of patients’ own decision making for chemotherapy in some situations. This ethical dilemma must be considered for adequately informed decision making for chemotherapy while ensuring the patients’ autonomy is maintained.

The senses of interns worked in hospice center

8162 Background: As the education on palliative & end-of-life care for physicians and the opportunity of clinical practice to treat terminally ill cancer patients is very insufficient. Methods: From January to October, 2004, questionnaire was performed to interns worked in Kangnam St. Mary’s hospital hospice center and in general ward except hospice center of the same hospital. Results: Demographics 20 interns worked in hospice center and 28 interns in general ward only. It was found that interns worked in hospice center participating in the treatment of advance cancer patients more than those worked in general ward only(66% vs 13%, p=0.0012). Collaboration with Supportive/Palliative care team Interns worked in hospice center maintained constant relation with palliative care medical specialist (p=0.0058), palliative care nurse specialist (p=0.0015), inpatient hospice (p=0.0147) and social worker (p=0.0329), thereby performing cooperative diagnosis and treatment. Direct participation in Supportive and Pall...