Meio University, Nago City, Japan.
National Cancer Center Hospital, Chuo-ku, Japan.
Jpn J Clin Oncol. 2020 Dec 16;50(12):1426-1433. doi: 10.1093/jjco/hyaa146.
The objectives of this study were to identify barriers to end-of-life discussion with advanced cancer patients and their families as perceived by oncologists, certified/specialized nurses in cancer nursing (hereafter, collectively referred to as 'nurses') and medical social workers, as well as to clarify their opinions about effective strategies to facilitate end-of-life discussion.
A questionnaire survey was distributed to 4354 medical professionals working at 402 designated regional cancer hospitals in Japan. Responses were obtained from 494 oncologists (valid response rate 30.7%), 993 nurses (46.7%) and 387 medical social workers (48.1%).
Among the barriers to end-of-life discussion with advanced cancer patients, factors related to patients and families, such as 'Family members' difficulty accepting loved one's poor prognosis', were recognized as the most important issues, which was the common view shared across the three types of medical professionals who participated in this study. Nurses and medical social workers were significantly more likely than oncologists to recognize as important issues 'Health care team disagreement about goals of care' and 'Lack of training to have conversations for end-of-life discussion'. To facilitate end-of-life discussion, 'providing mental and emotional support for the patients and their families after end-of-life discussion' was needed most as perceived by the respondents regardless of their profession.
Barriers impeding end-of-life discussion were factors related to patients and their families, and oncologists' close cooperation with nurses and medical social workers is important in providing emotional support for patients and families. To facilitate end-of-life discussion, it is important to share information on patients' prognosis and goals for treatment among oncologists and other medical professionals, as well as strengthen communication skill of these medical professions.
本研究旨在确定肿瘤学家、癌症护理认证/专科护士（以下统称“护士”）和医务社会工作者认为的与晚期癌症患者及其家属进行临终讨论的障碍，并阐明他们对促进临终讨论的有效策略的看法。
对日本 402 家指定区域癌症医院的 4354 名医疗专业人员进行了问卷调查。共收到肿瘤学家 494 份（有效应答率为 30.7%）、护士 993 份（46.7%）和医务社会工作者 387 份（48.1%）的回复。
在与晚期癌症患者进行临终讨论的障碍中，与患者及其家属相关的因素，如“家属难以接受亲人预后不良”，被认为是最重要的问题，这是参与本研究的三类医疗专业人员的共同观点。护士和医务社会工作者比肿瘤学家更有可能认为“医疗团队对护理目标存在分歧”和“缺乏进行临终讨论对话的培训”是重要问题。为了促进临终讨论，无论其专业如何，受访者都认为“为临终讨论后的患者及其家属提供心理和情感支持”是最需要的。
阻碍临终讨论的障碍是与患者及其家属相关的因素，肿瘤学家与护士和医务社会工作者密切合作，为患者及其家属提供情感支持非常重要。为了促进临终讨论，重要的是要在肿瘤学家和其他医疗专业人员之间共享有关患者预后和治疗目标的信息，并加强这些医疗专业人员的沟通技巧。
