Departmental Bulletin Paper 在宅療養高齢者の終末期医療に対する事前の意思表示の現状と課題
Current State and Issues Surrounding the Home-care Elderly’s Prior Expression of Will toward Their End-of -life Care

高橋, 方子  ,  菅谷, しづ子  ,  鈴木, 康宏  ,  石津, みゑ子  ,  布施, 淳子

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目的:本研究は訪問看護師の在宅療養高齢者の終末期医療の意思に関する認識から、事前の意思表示の現状と課題を検討することを目的とした。方法:訪問看護師756人を調査対象とし、郵送法にて無記名自記式質問紙調査を実施した。結果:133人から回答が得られ(回収率は17.6%)、回答に不備のあるものを除いた107人を分析対象とした。終末期医療に対する意思を事前に文書で伝えていた在宅療養高齢者は治療方針、臨終場所、医療処置の内容、代理判断者について平均1人にも満たない極めて少ない状況であり、口頭で意思を伝えていた人も平均4人に満たない状況だった。事前の意思表示の必要性は対象者のうち103人(96.2%)が「必要である」と回答した。また訪問看護師の終末期医療に対する意思把握の困難感および病気の見通しや病名の告知をまず説明すべき人についての回答理由はいずれにおいても意思決定能力の低下があげられていた。結論:現状では終末期医療に対する事前の意思表示を示している人は少ないが、事前の意思表示の必要性は高いと推測された。自分の人生観や死生観に根ざした終末期医療に対する意思を事前に考えられるような機会を如何に作るかが今後の課題であると考えられた。
Purpose:The purpose of this research is to consider the current state and issues surrounding the home-care elderly's prior expression of will toward their end-of -life care (hereinafter “End-of -life care”), by basing on the visiting nurse's awareness toward such issues.Method: We chose 756 visiting nurses as the survey subjects, and we had them fill out the answers without revealing their identity and had them mail back the survey.Result:Answers were obtained from 133(17.3%)visiting nurses (with 107 valid responses received). The result showed a staggeringly low number that did not even reach an average of 1 person, for the home-care elderlies who priory expressed their will in writing for their treatment policy, deathbed, description of medical treatment and authorized decision-maker on their behalf. The elderlies who verbally expressed such will also showed a low number of not even reaching an average of 4 persons. Out of survey subjects, 103 persons (96.2%) responded “necessary” when asked about the necessity of elderlies expressing one's will in advance. Furthermore, regarding the reason behind the answer to the questions “why is it difficult to assess the will of elderlies for their end-of -life care?” and “who should be the first person to be notified on the name/state of the illness?”, the subject visiting nurses stated “decline of elderly's decision-making capability” as such reason.Result: The result showed that although very few elderlies priory expressed their will toward their end-of -life care at present state, our speculation is that there is a high need for elderlies to express such will. For the future challenge, we need to figure out an arrangement so that elderlies will have a chance to priory express one's will for their end-of -life care in line with their view of life and death.
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