Department of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
J Pain Symptom Manage. 2012 Jan;43(1):59-67. doi: 10.1016/j.jpainsymman.2011.03.012. Epub 2011 Jun 23.
The role of general practitioners (GPs) and district nurses (DNs) is increasingly important to achieve dying at home.
The primary aim of this region-based representative study was to clarify 1) clinical exposure of GPs and DNs to cancer patients dying at home, 2) availability of symptom control procedures, 3) willingness to participate in out-of-hours cooperation and palliative care consultation services, and 4) reasons for hospital admission of terminally ill cancer patients.
Questionnaires were sent to 1106 GP clinics and 70 district nursing services in four areas across Japan.
Two hundred thirty-five GPs and 56 district nursing services responded. In total, 53% of GPs reported that they saw no cancer patients dying at home per year, and 40% had one to 10 such patients. In contrast, 31% of district nursing services cared for more than 10 cancer patients dying at home per year, and 59% had one to 10 such patients. Oral opioids, subcutaneous opioids, and subcutaneous haloperidol were available in more than 90% of district nursing services, whereas 35% of GPs reported that oral opioids were unavailable and 50% reported that subcutaneous opioids or haloperidol were unavailable. Sixty-seven percent of GPs and 93% of district nursing services were willing to use palliative care consultation services. Frequent reasons for admission were family burden of caregiving, unexpected change in physical condition, uncontrolled physical symptoms, and delirium.
Japanese GPs have little experience in caring for cancer patients dying at home, whereas DNs have more experience. To achieve quality palliative care programs for cancer patients at the regional level, educating GPs about opioids and psychiatric medications, easily available palliative care consultation services, systems to support home care technology, and coordinated systems to alleviate family burden is of importance.
全科医生和地区护士的角色对于实现在家中死亡的目标变得越来越重要。
本基于区域的代表性研究的主要目的是阐明 1）全科医生和地区护士对在家中死亡的癌症患者的临床接触情况，2）症状控制程序的可用性，3）参与非工作时间合作和姑息治疗咨询服务的意愿，以及 4）终末期癌症患者住院的原因。
向日本四个地区的 1106 家全科医生诊所和 70 家地区护理服务机构发送了问卷。
235 名全科医生和 56 家地区护理服务机构做出了回应。总的来说，53%的全科医生报告说他们每年没有看到在家中死亡的癌症患者，而 40%的全科医生每年有 1 到 10 名这样的患者。相比之下，31%的地区护理服务机构每年照顾超过 10 名在家中死亡的癌症患者，而 59%的地区护理服务机构每年有 1 到 10 名这样的患者。口服阿片类药物、皮下阿片类药物和皮下氟哌啶醇在超过 90%的地区护理服务机构中均可获得，而 35%的全科医生报告说口服阿片类药物不可用，50%的全科医生报告说皮下阿片类药物或氟哌啶醇不可用。67%的全科医生和 93%的地区护理服务机构愿意使用姑息治疗咨询服务。住院的常见原因是照顾者的家庭负担、身体状况的意外变化、无法控制的身体症状和谵妄。
日本的全科医生在照顾在家中死亡的癌症患者方面经验较少，而地区护士则经验更多。为了在区域层面上实现癌症患者的高质量姑息治疗计划，教育全科医生使用阿片类药物和精神科药物、提供容易获得的姑息治疗咨询服务、支持家庭护理技术的系统以及协调减轻家庭负担的系统非常重要。
