Kotake Rina, Hanari Kyoko, Iwagami Masao, Okochi Ziro, Ueshima Hiroaki, Tamiya Nanako
School of Medicine, School of Medicine and Medical Sciences, University of Tsukuba.
Doctoral Programs in Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
Nihon Koshu Eisei Zasshi. 2020;67(6):390-398. doi: 10.11236/jph.67.6_390.
Objectives In Japan, the proportion of older people receiving end-of-life care in geriatric health services facilities (GHSF) is increasing. However, to our knowledge, there have been no previous studies investigating the relationship between the structure of GHSFs and the quality of end-of-life care evaluated by bereaved families.Methods We secondarily analyzed data from the survey done by the Japan Association of Geriatric Health Services Facilities (JAGHSF) in January 2014. Study subjects were 3 recently bereaved family members who had experienced planned end-of-life care at different facilities of the JAGHSF.The dependent variable was the bereaved family members' satisfaction with end-of-life care, which was obtained based on the best answer out of a 5 point scale for the question "Didn't you regret your family member's death immediately after he/she died?" The independent variables included schemes of explanation of patients' conditions at GHSF, management, and education of facilities and staff by doctors. We conducted a univariate analysis, followed by a multivariable logistic regression analysis.Results For the final analysis, we included 363 bereaved family members, of which 250 (68.9%) were satisfied with the end-of-life care. In a multivariable logistic regression analysis, family members' satisfaction was significantly associated with regular medical consultation by doctors for facility users (adjusted odds ratio 2.94, 95% CI 1.52-5.70), explanation about patients' conditions at the time of admission by facility staff other than doctors (2.07, 1.01-4.25), explanation about patients' conditions at the time of deterioration by facility staff other than doctors (3.12, 1.17-8.33), and stress management by doctors for facility staff (3.63, 1.84-7.16).Conclusions Respect for the roles of the facility staff other than doctors, such as the participation of facility staff in explaining situations for facility users and family members and management of facility staff stress, may improve satisfaction with end-of-life care among bereaved family members. More attention is needed for these factors to improve the quality of end-of-life care in GHSFs.
目的 在日本，老年保健服务设施（GHSF）中接受临终关怀的老年人比例正在增加。然而，据我们所知，以前没有研究调查过GHSF的结构与丧亲家庭评估的临终关怀质量之间的关系。
方法 我们对日本老年保健服务设施协会（JAGHSF）在2014年1月进行的调查数据进行了二次分析。研究对象是3名最近丧亲的家庭成员，他们在JAGHSF的不同设施中经历了计划性临终关怀。
因变量是丧亲家庭成员对临终关怀的满意度，这是根据“您在家人去世后是否立即后悔其死亡？”这一问题的5分制最佳答案得出的。自变量包括GHSF中患者病情的解释方案、设施管理以及医生对设施和工作人员的培训。我们进行了单变量分析，随后进行了多变量逻辑回归分析。
结果 在最终分析中，我们纳入了363名丧亲家庭成员，其中250名（68.9%）对临终关怀感到满意。在多变量逻辑回归分析中，家庭成员的满意度与医生为设施使用者定期进行医疗咨询（调整后的优势比2.94，95%可信区间1.52 - 5.70）、非医生的设施工作人员在入院时对患者病情的解释（2.07，1.01 - 4.25）、非医生的设施工作人员在病情恶化时对患者病情的解释（3.12，1.17 - 8.33）以及医生对设施工作人员的压力管理（3.63，1.84 - 7.16）显著相关。
结论 尊重非医生设施工作人员的作用，如设施工作人员参与为设施使用者和家庭成员解释情况以及管理设施工作人员的压力，可能会提高丧亲家庭成员对临终关怀的满意度。为了提高GHSF中临终关怀的质量，需要更多关注这些因素。
