일 종합병원 암 환자의 사전연명의료의향서 작성여부에 따른 통증, 죽음에 대한 태도, 삶의 질의 차이

국문 초록 (Abstract)

본 연구는 입원 암 환자를 대상으로 사전연명의료의향서 작성여부에 따
른 통증, 죽음에 대한 태도, 삶의 질의 차이 파악하여 암 환자의 통증,
죽음에 대한 태도, 삶의 질을 변화시키며, 사전연명의료의향서 작성여부
에 따른 암 환자의 자기결정권에 기반한 다양한 프로그램 개발 및 정책
마련의 기초자료를 제공하고자 시도 된 서술적 비교 연구이다.
본 연구의 자료는 경상북도 소재 일 종합병원의 사전연명의료의향서 등
록기관에 입원한 암 환자 129명을 대상으로 자발적으로 연구 참여에 동
의한 자에게 구조화된 설문지를 이용하여 수집하였다. 자료수집 기간은
2020년 7월 15일부터 2021년 8월 1일까지며, 수집된 자료는 SPSS/WIN
25.0 program을 이용하여 빈도와 백분율, 평균과 표준편차, chi-squared
test(Fisher's exact test), ANOVA, t-test, Mann-Whit ney's test,
Wilcoxon signed rank test, paired t-test 로 분석하였다.
본 연구의 결과는 다음과 같다.
1. 사전연명의료의향서 작성군, 비작성군의 통증의 차이는 작성군 3.09(
±1.69)점, 미작성군 2.98(±1.47)점으로, 두 집단의 점수에는 유의한 차이
가 없는 것으로 나타났다(z=-0.089, p=.697).
2. 사전연명의료의향서 작성군, 비작성군의 죽음에 대한 태도 차이는 죽
작성군 52.09(±10.87)점, 미작성군 46.02(±7.34)점으로, 두 집단의 점수에
는 유의한 차이가 있는 것으로 나타났다(z=-2.875, p=.004).
3. 사전연명의료의향서 작성군, 비작성군의 삶의 질 차이는 작성군 59.44
(±9.90)점, 미작성군 56.91(±10.47)점으로, 두 집단의 점수에는 유의한 차
이가 없었다(t=1.409, p=.161).
4. 사전의료의향서 작성군의 작성 전·후 통증의 차이는 작성 전 3.36(±
1.90)점에서 작성 후 3.09(±1.69)점으로 유의하게 감소하는 것으로 나타났
다(z=-3.266, p=.001).
5. 사전의료의향서 작성군의 작성 전·후 죽음에 대한 태도 차이는 작성
전 44.28(±10.70)점에서 작성 후 52.09(±10.87)점으로 유의하게 증가하는
것으로 나타났다(z=-6.007, p<.001).
6. 사전의료의향서 작성군의 작성 전·후 삶의 질 차이는 작성 전 55.16(
±10.50)점에서 작성 후 59.44(±9.90)점으로 유의하게 증가하는 것으로 나
타났다(t=-4.977, p<.001).
7. 연구대상자의 일반적 특성 따른 통증, 죽음에 대한 태도, 삶의 질 차
이를 분석한 결과는 다음과 같다. 첫째, 사전연명의료의향서 작성군에서
통증은 유의한 차이가 없는 것으로 나타났다. 비작성군에서는 연령
(t=-5.524, p<.001), 학력(t=2.14, p=0.111), 죽음경험(F=6.475, p=.005)에서
유의한 차이가 있었다. 둘째, 사전연명의료의향서 작성군에서 죽음에 대
한 태도는 죽음경험(F=4.114, p=.024)에서 유의한 차이가 있었다. 비작성
군에서는 연령(t=4.286, p<.001), 학력(t=-3.667, p=.008), 소득수준
(t=2.860, p=. 006)에서 유의한 차이가 있었다. 셋째, 사전연명의료의향서
작성군에서 삶의 질은 성별(t=2.079, p=.042), 연령(t=2.423, p=.018)에서
유의한 차이가 나타났다. 비작성군에서는 연령(t= 8.108, p<.001), 학력
(t=-2.623, p=.011), 소득수준(t=3.402, p=.001)에서 유의한 차이가 있었다.
이상의 결과를 토대로 암 환자의 사전연명의료의향서 작성한 대상자는
통증에 영향을 주며 죽음에 대한 긍정적인 태도, 삶의 질이 높아졌으며,
본 연구에서는 사전연명의료의향서 작성군에서 통증, 죽음에 대한 태도,
삶의 질은 모두 유의한 차이가 있었으며, 사전연명의료의향서를 통해 죽
음에 대해 미리 생각하고 이를 받아드리면서 삶의 질을 개선시킬 수 있
을 것이라 생각된다. 추후 반복 연구를 통하여 사전연명의료의향서 작성
군과 비작성군의 통증, 죽음에 대한 태도, 삶의 질 간에 관련성을 확인해
볼 필요가 있다.

목차 (Table of Contents)

• <국문초록>
• 제1장 서론 ············································································································1
• 제1절 연구의 필요성 ························································································1
• 제2절 연구의 목적····························································································5
• 제3절 용어의 정의····························································································6
• 제2장 문헌고찰 ····································································································8
• 제1절 사전연명의료의향서··············································································8
• 제2절 암성 통증 ····························································································12
• 제3절 죽음에 대한 태도················································································15
• 제4절 암 환자의 삶의 질 ··············································································18
• 제3장 연구방법 ··································································································21
• 제1절 연구 설계 ······························································································21
• 제2절 연구대상 ·······························································································21
• 제3절 연구도구 ·······························································································22
• 제4절 자료수집 ·······························································································24
• 제5절 자료 분석방법 ······················································································25
• 제6절 윤리적 고려··························································································26
• 제4장 연구결과 ··································································································27
• 제1절 일반적 특성 ························································································27
• 제2절 일반적 특성에 따른 사전연명의료의향서 작성군과 비작성군의
• 통증의 차이··························································································29
• 제3절 일반적 특성에 따른 사전연명의료의향서 작성군과 비작성군의
• 죽음에 대한 태도의 차이 ··································································31
• 제4절 일반적 특성에 따른 사전연명의료의향서 작성군과 비작성군의
• 삶의 질의 차이 ····················································································33
• 제5절 사전연명의료의향서 작성여부에 따른 통증의 차이 ····················35
• 제6절 사전연명의료의향서 작성여부에 따른 죽음에 대한 태도 차이 36
• 제7절 사전연명의료의향서 작성여부에 따른 삶의 질 차이··················37
• 제8절 사전연명의료의향서 작성군의 작성 전·후에 따른
• 통증의 차이··························································································38
• 제9절 사전연명의료의향서 작성군의 작성 전·후에 따른
• 죽음에 대한 태도 차이······································································39
• 제10절 사전연명의료의향서 작성군의 작성 전·후에 따른
• 삶의 질 차이······················································································40
• 제5장 논의 ··········································································································41
• 제1절 연구의 의의 ······················································································48
• 제6장 결론 및 제언 ··························································································50
• 제1절 결론·······································································································50
• 제2절 제언·······································································································53
• 참 고 문 헌 ······································································································55
• 부 록 ·················································································································73