Quality end-of-life care for cancer patients is a global health priority, and nurses are instrumental in providing this care. However, little is known about nurses’ experiences and perceptions in end-of-life care settings in Korea. Aims: This scoping review examined Korean nurses’ end-of-life care experiences and assessed the state of research in this area.
Methods:
Systematic searches were conducted using 7 electronic databases (PubMed, CINAHL, Scopus, Embase, WPRIM, KCI, and RISS), and 17 studies were selected for review.
Findings:
Most studies were limited to cross-sectional, descriptive designs. Outcomes regarding end-of-life care measured in the studies were categorized into cognitive variables, emotional variables, participation/performance, and educational needs. Study results suggested low nurse knowledge and self-efficacy with regard to provision of end-of-life care. Perceived barriers to quality end of life care included difficulties in meeting family members’ needs. In addition, emotional outcomes associated with end-of-life care included high levels of nurse stress and burnout. Predictors of elevated stress included inability to provide adequate pain control, inability to reconcile patient requests with physician orders, and heavy workload. Although most nurses had end-of-life care experience, fewer than half reported receiving related education. The lack of knowledge and skill related to end of life care was a primary contributor to stress.
Conclusions:
Korean nurses providing end-of-life care for cancer patients need additional education and support to help them manage high stress levels. Further study is needed to identify strategies for meeting nurses’ end-of-life care education needs and of improving their overall performance in such practice.
BrayFFerlayJSoerjomataramISiegelRLTorreLAJemalA.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
2.
Worl ConnorSRBermedoMCS, eds. Global Atlas of Palliative Care at the End of Life. Worldwide Palliative Care Alliance, World Health Organization; 2014.
3.
ChoiSK. Current status of the management of cancer patients in Korea. J Korean Med Assoc. 2017;60(3):228–232.
4.
JoMYooYKnaflGVan RiperMBeeberLSongM. Family-clinician communication about end-of-life care in Korea. J Hosp Palliat Nurs. 2017;19(6):597–601.
5.
KimHSKimBH. Palliative care in South Korea. In: FerrellBRCoyleNPaiceJA, eds. Oxford Textbook of Palliative Nursing. 4th ed. Oxford University Press; 2015:1136–1143.
6.
Korea National Hospice Center, Ministry of Health and Welfare. Hospice and Palliative Care in Korea: Facts and Figures 2017. Ministry of Health and Welfare; 2019.
7.
HongMHongSAdamekMEKimMH. Death attitudes among middle-aged Koreans: role of end-of-life care planning and death experiences. Int J Aging Hum Dev. 2018;86(1):51–68.
8.
RheeY. Hospice and palliative care services in South Korea supported by the National health insurance (NHI) program. Health. 2015;7(06):689–695.
9.
SingerAEGoebelJRKimYS, et al.Populations and interventions for palliative and end-of-life care: a systematic review. J Palliat Med. 2016;19(9):995–1008.
10.
SchroederKLorenzK. Nursing and the future of palliative care. Asia Pac J Oncol Nurs. 2018;5(1):4–8.
11.
ChuahPFLimMLChooSL, et al.A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting. Proc Singapore Healthc. 2016;26(1):17–25.
12.
SekseRJTHunskårIEllingsenS. The nurse’s role in palliative care: a qualitative meta-synthesis. J Clin Nurs. 2018;27(1-2):e21–e38.
13.
ArkseyHO’MalleyL. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.
14.
ThomasALubarskySDurningSJYoungME. Knowledge syntheses in medical education: demystifying scoping reviews. Aca Med. 2017;92(2):161–166.
15.
TriccoACLillieEZarinW, et al.PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–473.
16.
GarrardJ. Health Sciences Literature Review Made Easy. 5th ed. Jones & Bartlett Learning; 2017.
17.
HigginsJPTThomasJChandlerJ, et al.,eds. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Jon Wiley & Sons; 2019.
18.
LucasPJAraiLBairdJLawCRobertsHM. Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Med Res Methodol. 2007;7(4). doi:10.1186/1471-2288-7-4
19.
JoIH. A study on recognition of cancer patients—focused on nurses and doctors. Korean J Hosp Palliat Care. 2002;2(1):58–74.
20.
JoK. Degree of suffering reported by Korean nurses in end-of-life care. Asian J Nurs Stud. 2004;7(2):33–41.
21.
LeeHYLeeYOChoiEYParkYM. A Comparison on stress and coping of bereavement care between nurses in the cancer unit and nurses in the general unit. Asian Oncol Nurs. 2007;7(1):26–35.
22.
KwonSHYangSKParkMHChoeSO. Assessment for the needs to develop hospice trainng program for nurses. Korean J Hosp Palliat Care. 2008;11(3):147–155.
23.
ChoiMLeeJKimSSKimDKimH. Nurses’ knowledge about end-of-life care: where are we?J Contin Educ Nurs. 2012;43(8):379–384.
24.
KimJHLeeH. Cancer unit nurses’ end-of-life care-related stress, understanding and training needs. Korean J Hosp Palliat Care. 2012;15(4):205–211.
25.
HongEJungMParkESRyuE. Death perceptions, death anxiety, and attitudes to death in oncology nurses. Asian Oncol Nurs. 2013;13(4):265–272.
26.
JoKHKimYJ. The impact of nurses’ attitude toward dignified death and moral sensitivity on their end-of-life care performance. Korean J Hosp Palliat Care. 2013;16(4):223–231.
27.
LeeJChoiMKimSSKimHKimD. Korean nurses’ perceived facilitators and barriers in provision of end-of-life care. Int J Nurs Pract. 2013;19(3):334–343.
28.
WooYWKimKHKimKS. Death anxiety and terminal care stress among nurses and the relationship to terminal care performance. Korean J Hosp Palliat Care. 2013;16(1):33–41.
29.
KwonSTaeYSHongMChoiGH. Hospice palliative nurses’ experience of caring for terminal cancer patients. Asian Oncol Nurs. 2015;15(4):264–275.
30.
YangKHKwonSI. The effects of attitude to death in the hospice and palliative professionals on their terminal care stress. Korean J Hosp Palliat Care. 2015;18(4):285–293.
31.
HeoKSParkEJ. Clinical nurses’ perceived or experienced obstacles and supportive behaviors in providing care for terminally ill cancer patients. Asian Oncol Nurs. 2016;16(3):147–157.
32.
KimHYNamKHKwonSH. Mediating effects of empathy and resilience on the relationship between terminal care stress and performance for nurses in a tertiary hospital. Korean J Hosp Palliat Care. 2017;20(4):253–263.
33.
BaekSYKangSJ. Pediatric nurses’ perceptions related to end-of-life care and turnover intention. Child Health Nurs Res. 2018;24(4):353–363.
34.
JungSYKimJH. Influence of positive psychological capital and death awareness on terminal care performance of hematooncology unit nurses. Korean J Hosp Palliat Care. 2019;22(2):77–86.
35.
ParkSJChoiSH. A study on the degrees of death orientation and terminal care performance of nurses. J Korean Acad Fundam Nurs. 1996;3(2):285–297.
36.
KimHKimK. Palliative cancer care stress and coping among clinical nurses who experience end-of-life care. J Hosp Palliat Nurs. 2020;22(2):115–122.
37.
MunnZPetersMDJSternCTufanaruCMcArthurAAromatarisE. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. 25.
BorsonS. Cognitive, aging, and disabilities: conceptual issues. Phys Med Rehabil Clin N Am. 2010;21(2):375–382.
41.
LeeY. A Study of Cancer Unit Nurses’ Stress from Bereavement Support. [master’s thesis]. Kyunghee University; 2004:64.
42.
AboshaiqahAE. Assessing palliative care knowledge among nurses in 2 hospitals in Saudi Arabia. J Hosp Palliat Nurs. 2019;21(3):e1–e6.
43.
Chover-SierraEMartínez-SabaterALapeña-MoñuxYR. An instrument to measure nurses’ knowledge in palliative care: validation of the spanish version of palliative care quiz for nurses. PLoS One. 2017;12(5). doi.org/10.1371/journal.pone.0180622
BlaževičienėANewlandJAČivinskienėVBeckstrandRL. Oncology nurses’ perceptions of obstacles and role at the end-of-life care: cross sectional survey. BMC palliative care. 2017;16(1):74.
46.
OmarDHEWongLPChongMCSubramanianP. Nurses’ perceptions of barriers and facilitators and their associations with the quality of end-of-life care. J Clin Nurs. 2018;27(3-4):e688–e702.
47.
ShinDWLeeJEChoBYooSHKimSYooJH. End-of-life communication in Korean older adults: with focus on advance care planning and advance directives. Geriatr Gerontol Int. 2016;16(4):407–415.
48.
ShinDWChoJKimSY, et al.Discordance among patient preferences, caregiver preferences, and caregiver predictions of patient preferences regarding disclosure of terminal status and end-of-life choices. Psychooncology. 2015;24(2):212–219.
49.
MelvinCS. Historical review in understanding burnout, professional compassion fatigue, and secondary traumatic stress disorder from a hospice and palliative nursing perspective. J Hosp Palliat Nurs. 2015;17(1):66–72.
50.
LemondeMPaymanN. Perceived roles of oncology nursing. Can Oncol Nurs J. 2015;25(4):422–442.
51.
WazqarDY. Oncology nurses’ perceptions of work stress and its sources in a university-teaching hospital: a qualitative study. Nurs Open. 2018;6(1):100–108.
52.
KwonSHChoYS. Current status of end-of-life care education in undergraduate nursing curriculum. Korean J Hosp Palliat Care. 2019;22(4):174–184.
53.
FerrellBMalloyPMazanecPViraniR. CARES: AACN’s new competencies and recommendations for educating undergraduate nursing students to improve palliative care. J Prof Nurs. 2016;32(5):327–333.
54.
KimHSKangKAKimS, et al.Palliative care competencies required of undergraduate nursing students in Korea. Korean J Hosp Palliat Care. 2019;22(3):117–124.
