Department of General Medicine, Kitasato University School of Medicine.
Tohoku J Exp Med. 2014 Jan;232(1):21-6. doi: 10.1620/tjem.232.21.
Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.
在老龄化迅速发展的日本，推广家庭医疗是非常必要的。在家庭医疗环境中，医生、患者和家庭之间的三方沟通是很常见的。“没有家庭参与的医生与患者之间的沟通”（医患沟通无家庭，简称“DPC 无家庭”）被认为对患者在不考虑家庭的情况下坦率地与医生进行沟通很重要。然而，DPC 无家庭的情况尚不清楚。因此，为了确定 DPC 无家庭发生的因素，我们针对之前接受过家庭医疗护理的 271 个日本患者家庭进行了横断面邮寄调查。在 227 名回应者（83.8%）中，我们最终分析了 143 名患者家庭的数据，排除了严重听力或认知障碍以及严重言语交流障碍患者的家庭。在分析的家庭中，有 26.6%（n=38）发生了 DPC 无家庭。使用包含主要疾病、日常活动、家庭医疗护理持续时间、就诊间隔、医生停留时间、是否存在其他房间以及配偶是否为主要照顾者的模型进行多变量逻辑回归分析。结果显示，DPC 无家庭与主要疾病为恶性肿瘤显著相关（OR，3.165；95%CI，1.180-8.486；P=0.022）。综上所述，就诊医生应牢记，DPC 无家庭发生的背景因素是患者的恶性肿瘤。
