Background
: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM).

Methods : A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association.

Results : Three hundred and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM.

Conclusion : These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.

Background
: Many terminal cancer patients and families are affected with physical, emotional, and social problems. Many people claim that a type of medical services is needed to manage them such as hospice·palliative care. There have not been many studies of cancer patients and families with respect to their opinions and attitudes on hospice·palliative care for terminal cancer patients, although their views on it is important.

Methods : We surveyed 687 in-patients, out-patients and their families with cancer in 8 hospitals. The self-administered questionnaires included the following; 1) socio-demographic and clinical variables; 2) opinions on hospice·palliative care; 3) attitudes on ethical issues associated with hospice·palliative care; 4) factors associated with withholding futile care at the end-of-life. The data were analyzed with x²-test, Mantel-Haenszel x²-test, and multiple logistic regression.

Results : Almost 90% of the subjects agreed to the need of obtaining hospice·palliative care with health care insurances and reaching a social consensus on the contents of its programs. Five hundred and seventy six (83.8%) subjects agreed to the need of using advanced directives. Two hundred and eighty five (72.2%) cancer patients and 200 (68.5%) families agreed to the need of withholding futile care at the end-of-life and of people accepting their cancer diagnosis with insight and living in the metropolis as they were more likely to do. In the multivariate analysis, the attitudes on withholding futile care at the end-of-life was significantly different only by insight of cancer diagnosis (OR; 1.09∼3.15).

Conclusion : This study showed that hospice·palliative care should be established through social consensus on the issues related to ethics and insurances, and that cancer patients and families must have a right to choose such services with informed decision-making.

Background
: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, there is no adequate medical service at present. We studied terminal cancer patients' behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families.

Methods : From 271 patients' families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we could have contacted were interviewed by three student nurses with a structured questionnaire.

Results : The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service.

Conclusion : There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.

Background
: Recently, cancer have become the major cause of death in Korea. But the diagnosis of the terminal cancer have been made, patients have been left alone without any discharge plan or have been admitted to a university hospital. In order to offer useful medical care to terminal cancer patients and to increase the efficiency of the sickbeds, it is needed to study the reasons for terminal cancer patients’ admission to a university hospital and problems associated with the admission.

Methods : Two groups of each 60 and 25 terminal cancer patients were randomly selected as subjects of. The patients were admitted to one university hospital located in Seoul and one university hospital located in a country city from Sep. 1, 1995 to Nov. 30, 1995. Their medical problems and treatment were reviewed. And through interviewing with patients’ chief doctor and families, we surveyed 69 patients’ reasons for admission, problems of home care, and the type of medical service needed by patients and familes.
Result: The most common medical problem precipitating the terminal care patient’s admission was pain(25.9%). 61.2% of chief doctors and 44.9% of family stated that the reason for admission to the hospital was symptom control including pain. Of 69 families who stated the place for patient’s death, 28(40.6%) chose the hospital. Concerning the worrying aspects of home care, 13(18.8%) families stated difficulty of admission, 10(14.5%) said inability to leave patient attended, 10 did inability to call medical personnel, 9 did no medical team for consultation. About 90% of the families wanted 24hr telephone service, readmission and continuous care of their hospital. Also, many families(about 70%) wanted admission to other hospital and care by other medical team. There was no significant difference between two university hospitals.

Conclusion : The main problems of care for terminal cancer patients were insufficiency of medical institutions and home care services for terminal cancer patients, and inappropriate symptom control. The refore, through introduction of home care service, establishment of palliative care centers and construction of strong connection with acute care institutions, we should be able to offer efficient and good medical service.

Background
: Informing patients of their cancer diagnosis is a difficult task for most physicians and is a traumatic event from the patient's point of view. With the remarkable development of medical science, prolongation of life is possible and some cancers are curable. Also, expanding medical technology has enabled nonsurgical physicians to sample tissues for pathologic examination. The doctor's office may become the primary place where the patients are told their cancer diagnosis in the future. Because there is little empirical literature to guide the clinician an how to inform the patients, and in what context to present cancer diagnosis, analysis of the experience of groups of cancer patients may be valuable in gaining a wider view of this issue.

Methods : Forty patients with knowledge on their cancer, undergoing chemotherapy were interviewed to learn how patients were told, their feelings how and where they were told, and the patient's opinion on how other patients should be told in the future.

Results : 45% of forty patients were told by physicians, 30% by family and 25% by accident. 57.5% of patients were told in the hospital room. 30% in the doctor's office and 12.5% in the home. When asked whether they should be told about cancer diagnosis 87.5% of all respondents answered "yes", 12.5% answered "dependent on situation" and none answered "no". When asked who should tell the diagnosis, 80% answered "doctor", and 20% answered "family". When asked who should be informed of the cancer diagnosis first, 62.5% of respondents answered "the family", 22.5% "the patient", 15% "simultaneously".

Conclusion : This study showed that cancer patient should be told the diagnosis and the informant should be the physician. This study also showed that in contrast to western society, the family should be considered in the presentation of cancer diagnosis. In order to achieve active participation of the patient in the treatment of their cancer, the doctor should inform the patients their cancer diagnosis in a hopeful and caring environment with the support of their family.