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[医疗专业人员的支持对临终关怀期间家庭决策的影响]

[The impact of support from medical professionals on families' decision-making during end-of-life care].

作者信息

Nakazato Kazuhiro, Wakui Tomoko, Kodama Hiroko, Shimada Chiho

机构信息

Department of Integrated Career Studies, Shokei University Junior college.

Tokyo Metropolitan Institute of Gerontology.

出版信息

Nihon Ronen Igakkai Zasshi. 2020;57(2):163-172. doi: 10.3143/geriatrics.57.163.

Abstract

Families are involved in decision-making regarding end-of-life (EOL) care in Japan. However, how support from medical professionals toward families' decision-making affects families' satisfaction with EOL care has not been adequately studied. We aimed to examine the impact of support from medical professionals considering the care recipients' preferences on families' overall satisfaction with EOL care and the mediating effect of fulfilling care recipients' preferences.We administered self-report questionnaires through home-nursing providers to bereaved families (n=753), who lost loved ones between April 2015 and March 2016. Analyses were conducted with 237 of these bereaved families whose loved ones had been ≥65 years old, and had no missing values in key variables. We asked whether the families had received any support from medical professionals in determining the care recipients' EOL preferences, in discussing how to honor the care recipients' own interests, and in supporting the families' decision-making. We also collected data measuring the overall satisfaction with EOL care, families' perceptions that the care recipients' preferences were honored during EOL care, and demographic characteristics of care recipients and caregivers.Data from 58 male and 179 female family members were analyzed. The average age was 65.8 (standard deviation [SD]=11.9) years. Care recipients were 113 men and 124 women, and their average age was 83.0 (SD=9.1) years old at the time of death. A path analysis revealed that support for families from medical professionals was related to families' satisfaction with EOL care through the mediating factor of fulfilling care recipients' preferences.Support from medical professionals considering care recipients' preferences will help families' involvement in EOL decision-making.

摘要

在日本,家庭会参与临终关怀(EOL)护理的决策过程。然而,医疗专业人员对家庭决策的支持如何影响家庭对临终关怀护理的满意度,尚未得到充分研究。我们旨在探讨考虑到受护理者偏好的医疗专业人员的支持,对家庭对临终关怀护理的总体满意度的影响,以及满足受护理者偏好的中介作用。

我们通过家庭护理服务机构,向在2015年4月至2016年3月期间失去亲人的丧亲家庭(n = 753)发放了自填式问卷。对其中237个丧亲家庭进行了分析,这些家庭的亲人年龄≥65岁,且关键变量无缺失值。我们询问了这些家庭在确定受护理者的临终偏好、讨论如何尊重受护理者自身利益以及支持家庭决策方面,是否得到过医疗专业人员的任何支持。我们还收集了衡量对临终关怀护理总体满意度的数据、家庭对临终关怀护理期间受护理者偏好得到尊重的看法,以及受护理者和护理人员的人口统计学特征。

对58名男性和179名女性家庭成员的数据进行了分析。平均年龄为65.8岁(标准差[SD]=11.9)。受护理者为113名男性和124名女性,他们在去世时的平均年龄为83.0岁(SD = 9.1)。路径分析表明,医疗专业人员对家庭的支持,通过满足受护理者偏好的中介因素,与家庭对临终关怀护理的满意度相关。

考虑到受护理者偏好的医疗专业人员的支持,将有助于家庭参与临终决策。

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