Yamagishi Akemi, Morita Tatsuya, Kawagoe Shohei, Shimizu Megumi, Ozawa Taketoshi, An Emi, Kobayakawa Makoto, Tsuneto Satoru, Shima Yasuo, Miyashita Mitsunori
Dept. of Community Health Care, Hamamatsu University School of Medicine.
Gan To Kagaku Ryoho. 2015 Mar;42(3):327-33.
Communicating with patients is clearly an integral part of physicians' practice, and introducing home hospice care is sometimes a difficult task for oncologists. The primary aims of this study were to clarify family-reported degree of emotional distress and the necessity for improvement in communication when introducing home hospice care, and to identify factors contributing to distress levels.
A multicenter questionnaire survey was conducted involving 1,052 family members of cancer patients who died at home at 15 home-based hospice services throughout Japan.
A total of 616 responses were analyzed(effective response rate of 60%). Fifty-nine percent of the bereaved family members reported that they were distressed or very distressed in receiving information about home hospice care, and 30% reported considerable or much improvement was necessary. There were 6 determinants of family-reported degree of emotional distress and the necessity for improvement: 1 ) Family distress was experienced when the physician stated that the disease progression defeated medicine and nothing could be done for the patient. 2 ) The physicians' explanation did not match with the state of family preparation. 3 ) There was no intimacy between hospital physician and home physician. 4 ) Physicians did not make the atmosphere relaxing enough to allow families to ask questions. 5 ) Nurses did not follow up to generate additional ideas to supplement the physician's statement. 6 ) Family members experienced pressure to make a rash decision.
In receiving information about transition of home care, a considerable number of families experienced high levels of emotional distress and felt a need for improvement in the communication style. This study proposes 6 strategies to alleviate family distress.
与患者沟通显然是医生临床工作中不可或缺的一部分，而向患者介绍居家临终关怀有时对肿瘤学家来说是一项艰巨的任务。本研究的主要目的是明确家属报告的情绪困扰程度以及在介绍居家临终关怀时沟通改善的必要性，并确定导致困扰程度的因素。
在日本全国15家居家临终关怀服务机构，对1052名在家中去世的癌症患者家属进行了多中心问卷调查。
共分析了616份回复（有效回复率为60%）。59%的丧亲家属报告称，他们在接受居家临终关怀信息时感到困扰或非常困扰，30%的家属报告称有必要进行大幅或很大程度的改善。家属报告的情绪困扰程度和改善必要性有6个决定因素：1）当医生表示疾病进展已非药物所能控制且对患者无能为力时，家属会感到困扰。2）医生的解释与家属的准备状态不符。3）医院医生与居家医生之间缺乏亲密感。4）医生营造的氛围不够轻松，使家属无法提问。5）护士没有跟进以提出补充医生陈述的更多想法。6）家属感到有仓促做决定的压力。
在接受居家护理转变的信息时，相当多的家庭经历了高度的情绪困扰，并认为沟通方式需要改进。本研究提出了6种减轻家属困扰的策略。
