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Communication for end-of-life care planning among Korean patients with terminal cancer: A context-oriented model

Published online by Cambridge University Press:  03 July 2015

Su Jin Koh
University of Ulsan College of Medicine, Ulsan University Hospital, Department of Hematology and Oncology, Ulsan, Korea
Shinmi Kim*
Changwon National University, Department of Nursing, Changwon, Korea
Jinshil Kim
Gachon University, College of Nursing, Incheon, Korea
Address correspondence and reprint requests to: Shinmi Kim, Associate Professor, Changwon National University Department of Nursing, 20 Changwondaehak-ro Uichang-gu Changwon-si, Gyeongsangnam-do 641-773Korea. E-mail:



In Korea, patients with terminal cancer are often caught out of the loop in end-of-life (EoL) care discussions. Healthcare professionals also have difficulty engaging in such communication in a variety of healthcare contexts. Therefore, the objective of our study was to develop a communication model for EoL care decision making compatible with the clinical environment in Korea.


Using focus-group interview methodology, participants included eight doctors and five nurses who provide EoL care for terminal cancer patients in acute hospital settings or hospice care facilities in various provinces of Korea.


Five themes emerged regarding EoL care discussion, which included: (1) timing, (2) responsible professionals, (3) disclosure of bad news, (4) content areas of EoL care discussion, and (5) implementing strategies for EoL care discussions. These themes were based on development of a communication algorithm for EoL discussion among patients with terminal cancer. A structural communication step for delivery of a terminal prognosis was specified at the phase of disclosure of bad news: beginning with determination of a patient's decision-making capability, followed by a patient's perception of his/her condition, a patient's wish to know, family dynamics, and a patient's and/or family's readiness for EoL discussions.

Significance of Results:

The proposed context-oriented communication algorithm could provide a helpful guideline for EoL communication and, accordingly, facilitate meaningful improvements in EoL care in Korean clinical practice. The feasibility of this algorithm has not yet been determined, and its validation in a larger sample of patients with terminal cancers, using a quantitative research methodology, is a priority of research.

Original Articles
Copyright © Cambridge University Press 2015 

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Berlinger, N., Jennings, B. & Wolf, S.M. (2013). The Hastings center guidelines for decisions on life-sustaining treatment and care near the end of life, 2nd ed.New York: Oxford University Press.CrossRefGoogle Scholar
Broom, A. & Cavenagh, J. (2011). On the meanings and experiences of living and dying in an Australian hospice. Health, 15(1), 96111.CrossRefGoogle Scholar
Burns, J.P. & Truog, R.D. (2007). Futility: A concept in evolution. Chest, 132(6), 19871993.CrossRefGoogle ScholarPubMed
Korean Ministry of Government Legislation (2013, March 23). Cancer Management Act No. 11690 Part 4: Palliative care for terminal cancer patients. Available from Scholar
Gade, G., Venohr, I., Conner, D., et al. (2008). Impact of an inpatient palliative care team: A randomized controlled trial. Journal of Palliative Medicine, 11(2), 180190.CrossRefGoogle Scholar
Greer, J.A., Jackson, V.A. & Meier, D.E., et al. (2013). Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: A Cancer Journal for Clinicians, 63(5), 349363.Google ScholarPubMed
Hsieh, H.F. & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 12771288.Google Scholar
Jack, B., Hillier, V., Williams, A., et al. (2004). Hospital-based palliative care teams improve the insight of cancer patients into their disease. Palliative Medicine, 18(1), 4652.Google Scholar
Kim, S.H., Son, M., Koh, S.O., et al. (2012). Intensive care providers' perceptions of medically futile treatment: Focus group interviews. Korean Journal of Medical Ethics, 15(3), 370384.CrossRefGoogle Scholar
Kim, S., Hong, Y., Hong, S.W., et al. (2013). Development of a Korean version of an advance directive model via cognitive interview. Korean Journal of Hospice & Palliative Care, 16(1), 2032.Google Scholar
Korean Statistical Information Service (KOSIS) (2013). Deaths and death rates by cause. Available from Scholar
Krueger, R.A. & Casey, M.A. (2009). Focus groups: A practical guide for applied research, 4th ed.Thousand Oaks, CA: Sage Publications.Google Scholar
Ministry of Health & Welfare (2012, August 27). Demo policy practice of hospice palliative care for terminal cancer patients, No. 2011 - 429. Available from .Google Scholar
Ministry of Health & Welfare (2013, July 31). Suggestion for the legislation of a special law of patient self-determination to make life-sustaining treatment. Available from Scholar
Morita, T., Fujimoto, K. & Imura, C. (2005 a). Trends toward earlier referrals to a palliative care team. Journal of Pain and Symptom Management, 30(3), 204205.CrossRefGoogle ScholarPubMed
Morita, T., Fujimoto, K. & Tei, Y. (2005 b). Palliative care team: The first year audit in Japan. Journal of Pain and Symptom Management, 29(5), 458465.Google Scholar
National Evidence-Based Healthcare Collaborating Agency (2009). A consensus statement on stopping meaningless end-of-life treatments in terminally ill patients. Available from Scholar
Ngo-Metzger, Q., August, K.J., Srinivasan, M., et al. (2008). End-of-Life care: Guidelines for patient-centered communication. American Family Physician, 77(2), 167174.Google ScholarPubMed
Rogne, L. & McCune, S.L. (2014). Advance care planning: Communicating about matters of life and death. New York: Springer.Google Scholar
Shrank, W.H., Kutner, J.S., Richardson, T., et al. (2005). Focus group findings about the influence of culture on communication preferences in end-of-life care. Journal of General Internal Medicine, 20(8), 703709.Google Scholar
Yun, Y.H., Lee, C.G., Kim, S.Y., et al. (2004). The attitude of cancer patients and their families toward the disclosure of terminal illness. Journal of Clinical Oncology, 22(2), 307314.Google Scholar