Kanoh Asako, Kizawa Yoshiyuki, Tsuneto Satoru, Yokoya Shoji
1 Department of Internal Medicine, Yoshida Hospital, Nara, Japan.
2 Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Am J Hosp Palliat Care. 2018 Jan;35(1):83-91. doi: 10.1177/1049909117696203. Epub 2017 Mar 10.
Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies.
This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan.
We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests.
The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care.
Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.
老年保健服务设施（GHSFs）作为老年人在回家前需要康复时的临时中间护理设施发挥着重要作用。然而，在这些设施中度过临终阶段的居民数量正在增加。为了提高临终护理质量，一些指南和研究建议进行临终讨论（EOLDs）。
本研究旨在阐明日本老年保健服务设施中临终护理和临终讨论的当前实践情况。
我们通过向3437名老年保健服务设施的总经理邮寄关于临终护理和临终讨论的问卷进行了一项全国性横断面调查。该问卷是通过文献综述以及研究人员和专家之间的讨论制定的。描述性统计总结了数据。我们还使用Fisher精确检验分析了与老年保健服务设施进行临终讨论相关的因素。
回复率为20.7%（3437人中的713人）。在受访者中，75.2%（713人中的536人）的老年保健服务设施提供临终护理，73.1%（713人中的521人）进行临终讨论。提供临终护理困难的最常见原因包括护士和护理人员缺乏临终教育以及他们对照顾濒死居民的恐惧。临终讨论大多在居民病情恶化后发起，由医生与家属进行。老年保健服务设施进行临终讨论的统计学显著因素包括为护士和护理人员提供临终教育、为重症居民提供私人房间、有随叫随到的急诊医生以及提供临终护理。
包括临终讨论在内的针对临终护理的充分实用的员工教育计划可能对老年护理机构的临终护理质量至关重要。
