Publications by authors named "Young Ho Yun"

156 Publications

Korean Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer.

J Pain Symptom Manage 2021 Jan 20. Epub 2021 Jan 20.

Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address:

Context: The goal of palliative care is to maximize the quality of life and thus maintain the dignity of patients facing problems associated with a life-threatening illness. The Patient Dignity Inventory (PDI) is an instrument used to measure various sources of distress that can impact patients' sense of dignity at the end of life.

Objectives: We aimed to obtain a Korean translation of the PDI (PDI-K) and evaluate its psychometric properties in patients with advanced cancer.

Methods: Translation and cultural adaptation of the PDI were performed to obtain the Korean version. In a sample of 131 inpatients and outpatients with advanced cancer, psychometric properties, including factor structure, internal consistency, and concurrent validity, were examined. Concurrent validity was evaluated using the Edmonton Symptom Assessment System, the Hospital Anxiety and Depression Scale, and the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being.

Results: Cronbach's α for the PDI-K was 0.96. Four factors were identified by exploratory factor analysis, accounting for 68.7% of the overall variance: Dependency and Physical Symptoms, Psychological Distress, Existential Distress, and SocialSupport. Concurrent validity was confirmed by significant correlations between PDI-K and Edmonton Symptom Assessment System (r = 0.40 to 0.59, P < 0.001), Hospital Anxiety and Depression Scale (r = 0.78 to 0.81, P < 0.001), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (r = -0.32 to -0.57, P < 0.001).

Conclusion: Our findings indicate that the PDI-K is a valid and reliable instrument to measure dignity-related distress in patients with advanced cancer. This tool provides a four-factor Korean language alternative to the PDI.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.01.003DOI Listing
January 2021

The Attitudes of Physicians and the General Public toward Prognostic Disclosure of Different Serious Illnesses: a Korean Nationwide Study.

J Korean Med Sci 2020 Dec 7;35(47):e401. Epub 2020 Dec 7.

Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.

Background: Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses.

Methods: We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea.

Results: For most illnesses, most physicians (adjusted proportions - end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was "the patient's right to know his/her condition" (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was "psychological burden such as anxiety and depression" (35.8%), while for the physicians it was "disclosure would have no beneficial effect" (42.4%).

Conclusion: Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.
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http://dx.doi.org/10.3346/jkms.2020.35.e401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721562PMC
December 2020

Effect of Changes in Patient's Self-management Strategies on Clinical Outcomes: Evidence from a Cohort Study of Patients with Diabetes, Hypertension, and Hyperlipidemia.

Int J Behav Med 2020 Nov 10. Epub 2020 Nov 10.

Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul, 03080, Korea.

Background: Self-management has become the dominant care model for chronic disease management. This study aimed to investigate the effect of changes in self-management strategies on the clinical outcomes of chronic diseases.

Methods: Two hundred ninety-seven patients with one or more chronic disease (diabetes, dyslipidemia, or hypertension) were registered and followed in this prospective cohort study. We compared differences in the changes in clinical outcomes from baseline to 6 months according to the improvement of self-management strategies by analysis of covariance.

Results: Diabetic patients with improved self-management strategies showed a significantly greater change in HbA1c levels compared to patients without improvement of self-management strategies (group difference in HbA1c = 0.51%). In hypertensive patients, systolic and diastolic blood pressure (BP) showed a significant decline in the patients with improved self-management strategies (group difference in systolic BP = 6.2 mmHg and in diastolic BP = 5.5 mmHg). Clinical outcomes improved significantly when self-management strategies improved in people with a poor self-management strategy at baseline.

Conclusions: This study suggests that improvements in self-management strategies are associated with an improvement in clinical outcomes among patients with chronic diseases, especially for those with an initially poor self-management strategy.
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http://dx.doi.org/10.1007/s12529-020-09937-xDOI Listing
November 2020

Self-management strategies and comorbidities in chronic disease patients: associations with quality of life and depression.

Psychol Health Med 2020 Oct 23:1-13. Epub 2020 Oct 23.

Department of Family Medicine, Seoul National University Hospital , Seoul, Republic of Korea.

Self-management strategies are essential for improving prognosis in chronic illnesses. This study aimed to investigate the association between comorbidity and self-management strategies. A total of 700 patients with one or more chronic diseases including diabetes, dyslipidemia, hypertension, osteoporosis, chronic lung disease, chronic kidney disease and arthritis were enrolled. A questionnaire including the Smart Management Strategy for Health Assessment Tool Short Form (SAT), the Short Form-12, the McGill Quality of Life questionnaire, and the Patient Health Questionnaire-9 was administered to participants. The trend of each SAT according to number of comorbidities was evaluated, and the difference in quality of life and depression according to self-management strategies was examined in the model classified by the number of diseases. Self-management strategy scores tended to decrease as the number of comorbidities increased from one to four (p-value: 0.001 to 0.008). Regardless of the number of comorbidities, the MQOL score was higher in the good self-management strategy group (p: <0.001 to 0.016). The prevalence of mild depression was higher in patients with low self-management strategy, but the differences were not significant. Based on these findings, self-management strategies should be evaluated multidimensionally, and patients should be encouraged to develop effective self-management strategies to manage multiple chronic diseases.
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http://dx.doi.org/10.1080/13548506.2020.1838585DOI Listing
October 2020

The major effects of health-related quality of life on 5-year survival prediction among lung cancer survivors: applications of machine learning.

Sci Rep 2020 07 1;10(1):10693. Epub 2020 Jul 1.

Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea.

The primary goal of this study was to evaluate the major roles of health-related quality of life (HRQOL) in a 5-year lung cancer survival prediction model using machine learning techniques (MLTs). The predictive performances of the models were compared with data from 809 survivors who underwent lung cancer surgery. Each of the modeling technique was applied to two feature sets: feature set 1 included clinical and sociodemographic variables, and feature set 2 added HRQOL factors to the variables from feature set 1. One of each developed prediction model was trained with the decision tree (DT), logistic regression (LR), bagging, random forest (RF), and adaptive boosting (AdaBoost) methods, and then, the best algorithm for modeling was determined. The models' performances were compared using fivefold cross-validation. For feature set 1, there were no significant differences in model accuracies (ranging from 0.647 to 0.713). Among the models in feature set 2, the AdaBoost and RF models outperformed the other prognostic models [area under the curve (AUC) = 0.850, 0.898, 0.981, 0.966, and 0.949 for the DT, LR, bagging, RF and AdaBoost models, respectively] in the test set. Overall, 5-year disease-free lung cancer survival prediction models with MLTs that included HRQOL as well as clinical variables improved predictive performance.
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http://dx.doi.org/10.1038/s41598-020-67604-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329866PMC
July 2020

Consumers' consciousness of health-friendly products and services and its association with sociodemographic characteristics and health status: a cross-sectional survey of the South Korean population.

BMJ Open 2020 06 21;10(6):e035591. Epub 2020 Jun 21.

Seoul National University Hospital, Jongno-gu, Seoul, The Republic of Korea.

Objectives: To identify consumers' consciousness of health-friendly products and services (consumer reaction, purchase intention and willingness to pay more) and its association with sociodemographic characteristics and multidimensional health status.

Methods: From March to May 2018, we administered questionnaires to 1200 individuals from the general Korean population asking about their perception of health-friendly labels, and if they would purchase such labelled products (foods, pharmaceuticals, etc) and services (purifying water, preventing air pollution, etc) at extra cost.

Results: The participants placed a high value on the importance of mental, social, spiritual and physical health factors in terms of the company's products and services with a score of about 8 out of 10 (range, 7.74-8.33). Most respondents (72.4%) said that they were interested in adopting health-friendly labels. When a health-friendly label is introduced (such as one by the Business for Social Responsiveness), 65.1% of the respondents said that they intended to purchase the product or service, while 6.8% said that they did not and 75.0% said that they were willing to pay extra for the health-friendly product or service. Multivariate logistic regression models showed urban residence, high education level and good social health to be significantly associated with positive attitudes towards health-friendly labels. People with high income, no religion or normal weight were more likely to say that they intend to purchase products and services with health-friendly labels. They also had a more positive attitude towards paying more for such products and services, as did people with good spiritual health.

Conclusion: This study provides data that illustrate the importance of health-friendly products and services to the general population and companies.
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http://dx.doi.org/10.1136/bmjopen-2019-035591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311022PMC
June 2020

Consumers' consciousness of health-friendly products and services and its association with sociodemographic characteristics and health status: a cross-sectional survey of the South Korean population.

BMJ Open 2020 06 21;10(6):e035591. Epub 2020 Jun 21.

Seoul National University Hospital, Jongno-gu, Seoul, The Republic of Korea.

Objectives: To identify consumers' consciousness of health-friendly products and services (consumer reaction, purchase intention and willingness to pay more) and its association with sociodemographic characteristics and multidimensional health status.

Methods: From March to May 2018, we administered questionnaires to 1200 individuals from the general Korean population asking about their perception of health-friendly labels, and if they would purchase such labelled products (foods, pharmaceuticals, etc) and services (purifying water, preventing air pollution, etc) at extra cost.

Results: The participants placed a high value on the importance of mental, social, spiritual and physical health factors in terms of the company's products and services with a score of about 8 out of 10 (range, 7.74-8.33). Most respondents (72.4%) said that they were interested in adopting health-friendly labels. When a health-friendly label is introduced (such as one by the Business for Social Responsiveness), 65.1% of the respondents said that they intended to purchase the product or service, while 6.8% said that they did not and 75.0% said that they were willing to pay extra for the health-friendly product or service. Multivariate logistic regression models showed urban residence, high education level and good social health to be significantly associated with positive attitudes towards health-friendly labels. People with high income, no religion or normal weight were more likely to say that they intend to purchase products and services with health-friendly labels. They also had a more positive attitude towards paying more for such products and services, as did people with good spiritual health.

Conclusion: This study provides data that illustrate the importance of health-friendly products and services to the general population and companies.
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http://dx.doi.org/10.1136/bmjopen-2019-035591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311022PMC
June 2020

Impact of family caregivers' awareness of the prognosis on their quality of life/depression and those of patients with advanced cancer: a prospective cohort study.

Support Care Cancer 2021 Jan 6;29(1):397-407. Epub 2020 May 6.

Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.

Purpose: A caregiver's prognostic awareness can affect clinical decisions for the patient. The purpose of this study was to examine the impact of family caregivers' prognostic awareness on the quality of life (QOL) and emotional state of both patients with advanced cancer and their caregivers.

Methods: This prospective cohort study was conducted from December of 2016 to January of 2018. A total of 159 patients with advanced cancer and an equal number of caregivers participated. The investigation tools used include the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15-Palliative, the McGill Quality of Life Questionnaire, and the Patient Health Questionnaire-9, and evaluation was performed at baseline, 3 months, and 6 months. Covariance analysis with a general linear modeling was used to compare changes in quality of life scores according to the caregivers' awareness of the prognosis.

Results: Mean patient overall QOL score increased in the group of caregivers who were aware of prognosis and decreased in the caregivers who were not aware of the prognosis (p = 0.018). The changes over time in the patients' QOL scores associated with symptoms improved with caregiver awareness (pain, p = 0.017; dyspnea, p = 0.048; appetite loss, p = 0.045). The percentage of depressed patients was smaller after 3 months in the group with caregivers aware of the prognosis (baseline to 3 months p = 0.028). Caregivers who did not understand their patients' prognosis exhibited better existential well-being (p = 0.036), and the incidence of depression was lower in this group at 3 months (p = 0.024).

Conclusion: Caregivers' prognostic awareness may improve the quality of life and mood in patients with advanced cancer; however, this awareness may harm the quality of life and mood of the caregivers. These results may aid in developing in-depth interventions regarding prognosis for both patients and their caregivers.
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http://dx.doi.org/10.1007/s00520-020-05489-8DOI Listing
January 2021

Efficacy of health coaching and a web-based program on physical activity, weight, and distress management among cancer survivors: A multi-centered randomised controlled trial.

Psychooncology 2020 07 23;29(7):1105-1114. Epub 2020 Apr 23.

Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Objectives: To investigate the efficacy of health coaching and a web-based program on survivor physical activity (PA), weight, and distress management among stomach, colon, lung and breast cancer patients.

Methods: This randomised, controlled, 1-year trial conducted in five hospitals recruited cancer survivors within 2 months of completing primary cancer treatment who had not met ≥1 of these behavioural goals: (i) conducting moderate PA for at least 150 minutes/week or strenuous exercise for over 75 minutes per week or, in the case of lung cancer patients, low or moderate intensity exercise for over 12.5 MET per week, (ii) maintaining normal weight, and (iii) attaining a score >72 in the Post Traumatic Growth Inventory (PTGI). Participants were randomly assigned to one of three groups: the control group, a web-only group, or a health coaching + web group. The primary endpoint was based on a composite of PA, weight, and PTGI score at 12 months.

Results: Patients in the health coaching + web group (difference = 6.6%, P = .010) and the web-only group (difference = 5.9%, P = .031) had greater overall improvements across the three-outcome composite than the control group. The health coaching + web group had greater overall improvement in PTGI (difference = 12.6%; P < .001) than the control group, but not in PA and weight.

Conclusion: The web-based program, with or without health coaching, may improve health behaviours including PA, weight, and distress management among cancer survivors within 2 months of completing primary cancer treatment. The web-based program with health coaching was mainly effective for reducing psychological distress.
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http://dx.doi.org/10.1002/pon.5394DOI Listing
July 2020

The Impacts of Prognostic Awareness on Mood and Quality of Life Among Patients With Advanced Cancer.

Am J Hosp Palliat Care 2020 Nov 13;37(11):904-912. Epub 2020 Feb 13.

Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.

Background: Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient's satisfaction and increase depression.

Aim: The purpose of this study is to assess whether patients' prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancer.

Design And Participants: In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients' prognostic awareness at baseline, 3 months, and 6 months.

Results: This study found significant differences in changes of QoL based on patients' prognostic awareness. From baseline to 3 months, emotional functioning ( = .039), pain ( = .042), existential well-being ( = .025), and social support ( = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning ( = .037), emotional functioning ( = .002), nausea/vomiting ( = .048), and constipation ( = .039) subscale scores and existential well-being scores ( = .025). No significant difference between the groups was found in terms of depression.

Conclusion: Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.
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http://dx.doi.org/10.1177/1049909120905789DOI Listing
November 2020

Efficacy of an Electronic Health Management Program for Patients With Cardiovascular Risk: Randomized Controlled Trial.

J Med Internet Res 2020 01 22;22(1):e15057. Epub 2020 Jan 22.

Seoul National University College of Medicine, Cancer Research Institute, Seoul, Republic of Korea.

Background: In addition to medication, health behavior management is crucial in patients with multiple risks of cardiovascular mortality.

Objective: This study aimed to examine the efficacy of a 3-month Smart Management Strategy for Health-based electronic program (Smart Healthing).

Methods: A 2-arm randomized controlled trial was conducted to assess the efficacy of Smart Healthing in 106 patients with at least one indicator of poor disease control and who had hypertension, diabetes, or hypercholesterolemia. The intervention group (n=53) took part in the electronic program, which was available in the form of a mobile app and a Web-based PC application. The program covered 4 areas: self-assessment, self-planning, self-learning, and self-monitoring by automatic feedback. The control group (n=53) received basic educational material concerning disease control. The primary outcome was the percentage of participants who achieved their clinical indicator goal after 12 weeks into the program: glycated hemoglobin (HbA) <7.0%, systolic blood pressure (SBP) <140 mmHg, or low-density lipoprotein cholesterol <130 mg/dL.

Results: The intervention group showed a significantly higher success rate (in comparison with the control group) for achieving each of 3 clinical indicators at the targeted goal levels (P<.05). Only the patients with hypertension showed a significant improvement in SBP from the baseline as compared with the control group (72.7% vs 35.7%; P<.05). There was a significant reduction in HbA in the intervention group compared with the control group (difference=0.54%; P≤.05). In the intervention group, 20% of patients with diabetes exhibited a ≥1% decrease in HbA (vs 0% among controls; P≤.05).

Conclusions: A short-term self-management strategy-based electronic program intervention may improve clinical outcomes among patients with cardiovascular risks.

Trial Registration: ClinicalTrials.gov NCT03294044; https://clinicaltrials.gov/ct2/show/NCT03294044.
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http://dx.doi.org/10.2196/15057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003122PMC
January 2020

The popularity of eating broadcast: Content analysis of "mukbang" YouTube videos, media coverage, and the health impact of "mukbang" on public.

Health Informatics J 2020 09 29;26(3):2237-2248. Epub 2020 Jan 29.

Seoul National University Hospital, Korea; Seoul National University College of Medicine, Korea.

As "mukbang" (eating broadcast) becomes increasingly widespread, there is growing interest about the impact of mukbang on public health. This study aimed to analyze the content of mukbang YouTube videos, as well as news articles related to mukbang and the association between watching mukbang videos and health habits. We analyzed 5952 YouTube mukbang videos, 5265 news articles, and a survey of 1200 people in Korea. In this study, we confirmed that the provocative content of mukbang YouTube videos, such as overeating, was related to video popularity (p < 0.001). In addition, more exposure to mukbang was associated with greater effects on dietary health due to mukbang (p < 0.001). The prevalence of news articles on the negative effects of mukbang showed an increasing trend over time, while the articles on "Mukbang is funny" were most common in all the years evaluated. To cope with public health problems such as obesity, it will be necessary to continue to investigate the content and effects of mukbang on public health.
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http://dx.doi.org/10.1177/1460458220901360DOI Listing
September 2020

Randomized Controlled Trial of Advance Care Planning Video Decision Aid for the General Population.

J Pain Symptom Manage 2020 06 19;59(6):1239-1247. Epub 2019 Dec 19.

Department of Family Medicine, Seoul National University Hospital, Jongno gu, Seoul, Korea; Department of Biomedical Science, Seoul National University College of Medicine, Jongno gu, Seoul, Korea. Electronic address:

Context: Advance care planning (ACP) in a healthy general population could improve the quality of care when a health problem arises.

Objectives: The purpose of this study was to evaluate the efficacy of video decision support aid in increasing the intention to document ACP in the general healthy population.

Methods: In this randomized controlled trial, we enrolled 250 members of the general population (aged 20 years and older and determined to be healthy), stratified by age and sex. The intervention was a video that provided information about ACP and end-of-life care options such as cardiopulmonary resuscitation (CPR) and palliative care. An attention-control arm was given a booklet about advance directives. Primary outcome was a change in intention to document ACP. Secondary outcomes included the intention to refuse CPR at terminal status, CPR and palliative care knowledge score, and the Hospital Anxiety and Depression Scale.

Results: About 250 participants were randomly assigned, half to the video-assisted intervention group and half to the attention-control group. Within one week postintervention, the intention to document ACP was significantly higher in the video-assisted intervention arm (68.0% vs. 39.2%; P < 0.001), and changes in the intention to document ACP were significantly greater in the video group than in the brochure group (P = 0.008; Δ = 14.4%). Palliative care knowledge score was also significantly increased in the video group (P = 0.036).

Conclusion: A well-constructed video decision support intervention can increase the intention to document ACP in the general population that presumably had little opportunity to discuss ACP with physicians.
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http://dx.doi.org/10.1016/j.jpainsymman.2019.12.353DOI Listing
June 2020

Association of illness understanding with advance care planning and end-of-life care preferences for advanced cancer patients and their family members.

Support Care Cancer 2020 Jun 26;28(6):2959-2967. Epub 2019 Nov 26.

Department of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea.

Purpose: Little has been determined regarding the association between patients' and families' illness understanding and preferences for medical care. We aimed to evaluate the association of illness understanding with advance care planning (ACP) and preferences for end-of-life care, such as aggressive care, early palliative care (EPC), and hospice care, among advanced cancer patients and their family caregivers.

Methods: Patients were recruited for a prospective cohort study at outpatient and inpatient facilities in nine university hospitals in Korea (n = 150), and their primary family caregivers were also asked to participate (n = 101). Data on ACP and end-of-life care preferences were collected only at baseline in the cohort study with optional questions and were used to analyze these study results.

Results: Patients with illness understanding were more likely to have documented physician orders for life-sustaining treatment (POLSTs) (adjusted odds ratio [aOR] of 4.94) and to have discussed ACP with their families (aOR 2.15) than those who did not. Being expected to live for several months, they were unlikely to prefer active treatment. Caregivers understanding patients' illness were more likely to write advance directives (ADs) and to discuss ACP; furthermore, they had already discussed ACP with family members. They did not prefer active treatment or life-sustaining treatments when their family members were expected to die within a few weeks. There was no significant association between illness understanding and preferences for EPC.

Conclusion: Accurately recognizing an incurable disease is associated with preferences for more ACP and less aggressive care but not with preferences for EPC or hospice care among both advanced cancer patients and their family caregivers.
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http://dx.doi.org/10.1007/s00520-019-05174-5DOI Listing
June 2020

Prevalence and associated factors of depression among Korean adolescents.

PLoS One 2019 16;14(10):e0223176. Epub 2019 Oct 16.

Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea.

This study aimed to identify factors significantly associated with recent depressive mood with respect to health-related behavioral patterns at the individual level, perceived safety in the school environment, and willingness to share concerns with family and social networks. Self-reported responses to questions regarding recent feelings of depression, health-related behaviors in physical, psychological, and spiritual subdomains, school refusal and perceived safety at school, and perceived social support were obtained from 1,991 in-school adolescents (mean [SD] age = 15.3 [1.7] years; male/female = 936/1055). Multivariate logistic regression analyses were used to identify explanatory factors significantly associated with recent depression, defined as feelings of sadness or hopelessness for more than 2 weeks (during the last 12 months) that interfered with everyday functioning. Of the 1,991 students, 271 (13.6%) reported recent depression. Multivariate logistic regression analyses revealed higher odds of recent depression in adolescents with frequent thoughts of school refusal (odds ratio [95% confidence interval] = 3.25 [2.44-4.32]) and those who engaged in regular physical exercise (1.57 [1.19-2.07]), whereas a positive mindset (0.65 [0.49-0.86]), perceived safety at school (0.62 [0.47-0.82]), and perceived social support from one's mother (0.54 [0.40-0.72]) were associated with lower odds of recent depression. Taken together, our findings suggest that parents and teachers should talk regularly with adolescents about recent life (dis)satisfaction and stressors, particularly when they report frequent thoughts of school refusal. Perceived social support would increase perceived safety on school grounds and make it easier for teenagers to share their concerns with parents, thereby reducing the risk for depressive symptoms. School-based programs that promote a positive mindset would be helpful in preparing students for the challenges of adulthood.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223176PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795486PMC
March 2020

Efficacy of a Decision Aid Consisting of a Video and Booklet on Advance Care Planning for Advanced Cancer Patients: Randomized Controlled Trial.

J Pain Symptom Manage 2019 12 20;58(6):940-948.e2. Epub 2019 Aug 20.

Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.

Context: Few randomized controlled trials of advance care planning (ACP) with a decision aid (DA) show an effect on patient preferences for end-of-life (EOL) care over time, especially in racial/ethnic settings outside the U.S.

Objectives: The objective of this study was to examine the effect of a decision aid consisting of a video and an ACP booklet for EOL care preferences among patients with advanced cancer.

Methods: Using a computer-generated sequence, we randomly assigned (1:1) patients with advanced cancer to a group that received a video and workbook that both discussed either ACP (intervention group) or cancer pain control (control group). At baseline, immediately after intervention, and at 7 weeks, we evaluated the subjects' preferences. The primary outcome was preference for EOL care (active treatment, life-prolonging treatment, or hospice care) on the assumption of a fatal disease diagnosis and the expectation of death 1) within 1 year, 2) within several months, and 3) within a few weeks. We used Bonferroni correction methods for multiple comparisons with an adjusted P level of 0.005.

Results: From August 2017 to February 2018, we screened 287 eligible patients, of whom 204 were enrolled to the intervention (104 patients) or the control (100 patients). At postintervention, the intervention group showed a significant increase in preference for active treatment, life-prolonging treatment, and hospice care on the assumption of a fatal disease diagnosis and the expectation of death within 1 year (P < 0.005). Assuming a life expectancy of several months, the change in preferences was significant for active treatment and hospice care (P < 0.005) but not for life-prolonging treatment. The intervention group showed a significant increase in preference for active treatment, life-prolonging treatment, and hospice care on the assumption of a fatal disease diagnosis and the expectation of death within a few weeks (P < 0.005). From baseline to 7 weeks, the decrease in preference in the intervention group was not significant for active treatment, life-prolonging treatment, and hospice care in the intervention group in the subset expecting to die within 1 year, compared with the control group. Assuming a life expectancy of several months and a few weeks, the change in preferences was not significant for active treatment and for life-prolonging treatment but was significantly greater for hospice care in the intervention group (P < 0.005).

Conclusion: ACP interventions that included a video and an accompanying book improved preferences for EOL care.
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http://dx.doi.org/10.1016/j.jpainsymman.2019.07.032DOI Listing
December 2019

Predicting Disease-Free Lung Cancer Survival Using Patient Reported Outcome (PRO) Measurements with Comparisons of Five Machine Learning Techniques (MLT).

Stud Health Technol Inform 2019 Aug;264:1588-1589

Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea.

The study was to develop the lung cancer patients' prediction model for predicting 5-year survival after completion of treatment by using Machine Learning Technology (MLT), adding patient reporting (PRO) measurements of lung cancer survivors to a variety of clinical parameters. Finally, the survival prediction models with the addition of lung cancer survivors' PRO measurements to the well-known clinical variables, based on diverse MLT, improved the predictive performance that explains 5-year disease-free lung cancer survival.
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http://dx.doi.org/10.3233/SHTI190548DOI Listing
August 2019

Comparison of quality of life and health behaviors in survivors of acute leukemia and the general population.

Ann Hematol 2019 Oct 23;98(10):2357-2366. Epub 2019 Jul 23.

Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.

We aimed to compare the health-related quality of life and health behaviors of acute leukemia (AL) survivors with that of the general population from two cohorts. AL survivors (n = 149) completed a set of questionnaires to evaluate quality of life, mental status, and health behaviors. AL survivors had more physical and mental difficulties (problems with usual activities, 15% vs. 5%, p < 0.001; anxiety or depression, 24% vs. 9%, p < 0.001; pain, 35% vs. 20%, p = 0.002) and more financial difficulties (p < 0.001) than the general population. Survivors who received stem cell transplantation (SCT) had significantly worse problems with role functioning, fatigue, pain, dyspnea, and insomnia, and had higher depression scores than chemotherapy group (p = 0.024). In terms of health behaviors, AL survivors had lower rates of smoking and drinking and higher influenza vaccination rates than the general population. However, only 17% of survivors had been recommended to receive screening for other cancers from health-care providers, and 67% thought their risk for other cancers was equal or lower than that of the general population. Cancer screening rates were even lower in the SCT group than in the chemotherapy group (p = 0.041). Our study indicates that clinicians should establish more appropriate survivorship care plans.
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http://dx.doi.org/10.1007/s00277-019-03760-5DOI Listing
October 2019

Correction to: Priorities of a "good death" according to cancer patients, their family caregivers, physicians, and the general population: a nationwide survey.

Support Care Cancer 2019 Oct;27(10):3921-3926

Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

While recently extending that research, however, we discovered that 236 members of the general population were mistakenly duplicated by the investigating agency (Word Research) and 1241 were reported rather than 1005. Here, we present corrections and discuss the relevant data.
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http://dx.doi.org/10.1007/s00520-019-04985-wDOI Listing
October 2019

Public support for health taxes and media regulation of harmful products in South Korea.

BMC Public Health 2019 May 30;19(1):665. Epub 2019 May 30.

Department of Family Medicine and Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.

Background: Public health policy is inevitably associated with either a strong presence or lack of public support. We investigated factors associated with both the public support of and opposition to health taxes and the media regulation regarding advertising harmful products in Korea.

Methods: We interviewed 1200 respondents that were recruited using an equal-probability sampling method in accordance with the 2016 Korean census. Our investigation examined the extent of support and opposition towards health taxes and the media regulation of advertising that targets the consumption of tobacco, alcohol, and unhealthy foods according to socioeconomic characteristics, health habits, body mass index (BMI), and exposure to the advertising of harmful products. The study was conducted using a univariate and stepwise multivariate regression analysis.

Results: The majority (71.8%) of the respondents were supportive of imposing health taxes in general. Despite a high prevalence of tobacco and alcohol consumption among the respondents, they strongly supported media regulation of tobacco (72.3%), alcohol (63.7%), and eating broadcasts (51.9%) food advertising (44.0%). Those that were non-smokers, earned a high-income, were married, or had a child were likely to support at least one kind of regulation regarding alcohol and smoking related advertising. An exposure to excessive advertising of unhealthy products was associated with increase of respondents supporting the media regulation. Those who regarded the media as being influential seemed to be more supportive of health taxes or media regulation.

Conclusion: Our results indicated strong public support among the respondents for health taxes and the media regulation regarding the advertising of unhealthy products. Based on our data, we are optimistic that countries whose population show a high rate of tobacco, alcohol or unhealthy food consumption may launch public policy in addressing these factors.
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http://dx.doi.org/10.1186/s12889-019-7044-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543563PMC
May 2019

The Satisfaction with Life Scale and the Subjective Well-Being Inventory in the General Korean Population: Psychometric Properties and Normative Data.

Int J Environ Res Public Health 2019 04 30;16(9). Epub 2019 Apr 30.

Department of Biomedical Science, Seoul National University College of Medicine, Seoul 03080, Korea.

This study aims to evaluate the psychometric properties of the Satisfaction with Life Scale (SWLS) and the Subjective Well-Being Inventory (SWBI) in a nationally representative sample in Korea. A total of 1200 people completed the semi-structured, self-reported questionnaire, which included five items from the SWLS and 14 items from the SWBI. All items and the total score of both the SWLS and the SWBI showed high internal consistency (with Cronbach's alphas of 0.886 and 0.946, respectively). The item-total correlation values for both measures were in the ranges of 0.71-0.75 and 0.65-0.80, respectively. There were positive correlations between the SWLS and SWBI ( = 0.59, = 0.01). The SWLS, SWBI and global well-being (GWB) scores were positively correlated with the McGill Quality of Life subscales ( = 0.01) but negatively correlated with the Patient Health Questionnaire-9 ( = 0.01). Participants under 50 years old (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.00-1.69) and those in rural areas (aOR = 1.63, 95% CI = 1.28-2.07) had higher scores on the SWLS than other participant groups. Participants who were under 50 years old (aOR = 1.47, 95% CI = 1.12-1.92), were male (aOR = 1.33, 95% CI = 1.04-1.71), were married (aOR = 1.51, 95% CI = 1.13-2.01), lived in rural areas (aOR = 2.30, 95% CI = 1.35-3.91), or had higher incomes (aOR = 1.30, 95% CI = 1.02-1.65) showed higher SWBI scores. This study showed that the SLWS and SWBI have good psychometric properties and could be applicable to Korea.
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http://dx.doi.org/10.3390/ijerph16091538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539707PMC
April 2019

Establishment of Normative Self-Rated Health Status Data and Association between Ideal Life Expectancy and Social Wellness of General Population in Korea.

Asian Nurs Res (Korean Soc Nurs Sci) 2019 May 23;13(2):99-106. Epub 2019 Feb 23.

Department of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Purpose: The purpose of this study was to establish normative data for holistic health parameters in the general Korean population and to investigate the factor associated with ideal life expectancy (ILE) among these holistic health parameters and sociodemographic variables.

Methods: This study used a questionnaire to obtain self-reported physical, mental, social, spiritual, and general health status and then evaluated their association with ILE. A total of 1,241 individuals responded to the questionnaire, from which we established a multidimensional health status reference data set representing the Korean population. To explain factors associated with ILE, we stratified results by age and gender and performed multiple logistic regression of sociodemographic variables and multidimensional health status.

Results: Women reported poor health status more frequently for all five health categories. The average ILE was 87.46 years versus 84.42 years of life expectancy in the general Korean population. Single marital status, higher income, and better social health were significantly associated with higher ILE.

Conclusion: ILE could be a good indicator reflecting social wellness in a certain society. Comprehensive social health promotion programs can improve individuals' attitudes toward life expectancy, especially for vulnerable groups.
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http://dx.doi.org/10.1016/j.anr.2019.02.002DOI Listing
May 2019

Correction to: The impact of caregiver's role preference on decisional conflicts and psychiatric distresses in decision making to help caregiver's disclosure of terminal disease status.

Qual Life Res 2019 Jun;28(6):1693

Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

In the original publication of the article, the incorrect grant number HC13C1391 was published in the acknowledgement section. The correct grant number is HC15C1391.
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http://dx.doi.org/10.1007/s11136-019-02124-wDOI Listing
June 2019

Novel combined measurement system to characterize film structures by spectral interferometry and ellipsometry.

Opt Express 2018 Dec;26(26):34396-34411

We propose a novel measurement system to simultaneously measure surface and thickness profiles of thin film structures, which cannot be realized in typical measurement techniques. This measurement is accomplished by combining spectral interferometry and ellipsometry. These two distinct measurement techniques are involved in a single system by the abnormal optical configuration. Further, the measurement results are complementary in order to characterize film structures. Film thickness profiles are measured by spectroscopic imaging ellipsometry and surface profiles are obtained from the spectral phase by spectrally resolved interferometry. This method eliminates the theoretical spectral phase by film thicknesses. The proposed system can determine the dimensional film structures at once, even though they have multi-layered films, substrate textures, and even thin film layers. In the experiments, each measurement principle was fundamentally verified with standard specimens. Further, a 4-layered film specimen was measured in order to reconstruct its 3D film structure. As the result, the repeatability of spectroscopic imaging ellipsometry was less than 1 nm and that of spectrally resolved interferometry was a few nanometers, which dominantly affected the performance of the whole system. Several issues for improving accuracy and precision of the proposed system are also discussed in this paper.
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http://dx.doi.org/10.1364/OE.26.034396DOI Listing
December 2018

Aspirin Does Not Prevent Pancreatic Cancer in a Large Asian Cohort.

Cancer Epidemiol Biomarkers Prev 2019 04 14;28(4):826-828. Epub 2019 Jan 14.

Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.

Background: Evidence has suggested that aspirin reduces the incidence of several cancers, but these benefits may not occur with pancreatic cancer.

Methods: A 12-year nationwide longitudinal cohort merged with the health checkup data was divided into "exposure ascertainment period" and "outcome ascertainment period" to avoid immortal time bias. The daily defined dose system was used to indicate the drug exposure.

Results: We found no significant association between aspirin use and incident pancreatic cancer based on HR.

Conclusions: Aspirin does not prevent pancreatic cancer.

Impact: A large Asian cohort study with reliable medication information affirms no impact of aspirin on pancreatic cancer development.
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http://dx.doi.org/10.1158/1055-9965.EPI-18-1325DOI Listing
April 2019

Attitudes of the General Public, Cancer Patients, Family Caregivers, and Physicians Toward Advance Care Planning: A Nationwide Survey Before the Enforcement of the Life-Sustaining Treatment Decision-Making Act.

J Pain Symptom Manage 2019 04 27;57(4):774-782. Epub 2018 Dec 27.

Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Health Policy and Management, Seoul National University, Seoul, Seoul, Republic of Korea. Electronic address:

Context: To respect a patient's wish for end-of-life care, "the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life" was enacted in South Korea in 2016. Current understanding of people who would be involved in advance care planning (ACP) is crucial to disseminate it systematically.

Objectives: The objective of this study was to investigate awareness and attitudes toward ACP in South Korea.

Methods: A multicenter, nationwide cross-sectional study was conducted, a survey regarding ACP among four groups that would have different positions and experiences: 1001 cancer patients, 1006 family caregivers, 928 physicians, and 1241 members of the general public.

Results: A total of 15% of the general population, 33% of the patients and caregivers, and 61% of the physicians had knowledge of advance directives. More than 64% of the general population, above 72% of the patients and caregivers, and 97% of the physicians were willing to do so when the disease status was aggravated or terminal. The possibility for changing the plan, uncertainty as to whether directives would actually be followed, and psychological discomfort were common reasons for not wanting to engage in ACP. Routine recommendations for a specific medical condition, heightened accessibility, and health insurance support were common factors that could help facilitate ACP.

Conclusion: Our findings suggest that strategies for promoting ACP should reflect different perspectives among the general public, patients, family caregivers, and physicians. Public advocacy, resources for approaching and integrating ACP into routine health care, as well as systematic support provisions are needed.
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http://dx.doi.org/10.1016/j.jpainsymman.2018.12.332DOI Listing
April 2019

Discordance between Physician and the General Public Perceptions of Prognostic Disclosure to Children with Serious Illness: a Korean Nationwide Study.

J Korean Med Sci 2018 Dec 26;33(49):e327. Epub 2018 Nov 26.

Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea.

Background: It is difficult to decide whether to inform the child of the incurable illness. We investigated attitudes of the general population and physicians toward prognosis disclosure to children and associated factors in Korea.

Methods: Physicians working in one of 13 university hospitals or the National Cancer Center and members of the general public responded to the questionnaire. The questionnaire consisted of the age appropriate for informing children about the prognosis and the reason why children should not be informed. This survey was conducted as part of research to identify perceptions of physicians and general public on the end-of-life care in Korea.

Results: A total of 928 physicians and 1,241 members of the general public in Korea completed the questionnaire. Whereas 92.7% of physicians said that children should be informed of their incurable illness, only 50.7% of the general population agreed. Physicians were also more likely to think that younger children should know about their poor prognosis compared with the general population. Physicians who opposed incurable illness disclosure suggested that children might not understand the situation, whereas the general public was primarily concerned that disclosure would exacerbate the disease. Physicians who were women or religious were more likely to want to inform children of their poor prognosis. In the general population, gender, education, comorbidity, and caregiver experience were related to attitude toward poor prognosis disclosure to children.

Conclusion: Our findings indicate that physicians and the general public in Korea differ in their perceptions about informing children of poor prognosis.
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http://dx.doi.org/10.3346/jkms.2018.33.e327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262186PMC
December 2018

Regional Differences in Colorectal Cancer Mortality Between 2000 and 2013 in Republic of Korea.

J Epidemiol 2019 Oct 6;29(10):399-405. Epub 2018 Oct 6.

Department of Preventive Medicine, Seoul National University College of Medicine.

Objective: Colorectal cancer (CRC) is the fourth most common site for cancer death in the Republic of Korea. The aim of this study was to describe the trends of colorectal cancer mortality by region.

Methods: CRC mortality trends in Republic of Korea were described by region using a Joinpoint regression model in both sexes. The annual percent changes (APCs) were calculated for each segment. Visualization of the changes in mortality rate of colorectal cancer death rates by 16 geographic areas in both sexes between 2000-2004 and 2009-2013 were also conducted.

Results: CRC mortality rates of men showed decreasing trend after increase in Daegu, Gyeongsangnam-do, and Chungcheongbuk-do between 2000 and 2013 based on the joinpoint model, while Gwangju, Jeollabuk-do, Jeollanam-do, and Gyeongsangbuk-do showed increase in CRC mortality during the same period. For women, CRC mortality of Seoul, Incheon, Daejeon, and Gyeongsangnam-do started to decrease in 2005, 2003, 2007, and 2006, respectively. The mortality rate for CRC in the eastern regions, which had relatively low rates of CRC among men in 2000 through 2004, reached a level similar to that in the northwestern regions of 2009 through 2013, while the highest CRC mortality rates in women was observed in Chungcheongbuk-do.

Conclusions: Reduction in CRC mortality varied across 16 metropolitan cities and provinces in men, and the visualization pattern showed that the east side of South Korea had the least progress in mortality reduction.
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http://dx.doi.org/10.2188/jea.JE20170331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737187PMC
October 2019