姑息治疗病房中与家庭冲突相关的临床和沟通因素：日本丧亲家庭的一项调查
Clinical and Communication Factors Associated With Family Conflict in Palliative Care Units: A Survey of Bereaved Families in Japan.
作者信息
Hamano Jun, Masukawa Kento, Mori Masanori, Yamaguchi Takashi, Otani Hiroyuki, Ishiki Hiroto, Hatano Yutaka, Maeda Isseki, Tsuneto Satoru, Shima Yasuo, Morita Tatsuya, Kizawa Yoshiyuki, Miyashita Mitsunori
机构信息
Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
出版信息
Cancer Med. 2025 Sep;14(17):e71192. doi: 10.1002/cam4.71192.
BACKGROUND
Family conflict is a common problem in palliative care and has been identified as a potential barrier to providing appropriate care. Several demographic factors associated with family conflict have been reported; however, associated clinical factors, including symptoms, treatments, and communication, remain to be elucidated.
AIMS
The aim of this study was to identify symptoms, treatments, and communication factors associated with family conflict in palliative care units (PCUs).
METHODS
We used matched data for deceased patients from a prospective cohort study conducted between January 2017 and December 2017 of cancer patients admitted to PCUs and their bereaved families from a nationwide cross-sectional questionnaire survey in Japan. We assessed family conflict using the Outcome-Family Conflict Scale.
RESULTS
We sent out 667 questionnaires, of which 443 (66.4%) were returned. We excluded 81 family members who refused to participate; therefore, we analyzed 362 (81.7%) responses. The mean age of the patients who died of cancer was 73.9 ± 11.3 years, and 51.9% were men. Multivariate logistic regression revealed a significant association between rapid deterioration of the patient's condition, resulting in death within 1-2 days, and family conflict about what is meant by "a good death" (p = 0.044, odds ratio: 2.66), and the presence of family members who insulted or yelled at other family members (p = 0.005, OR: 3.22). In addition, a significant association was found between the confirmation of the family's wishes regarding CPR during hospitalization and family conflicts about healthcare decisions for their relative (p = 0.013, OR: 0.46), about the way a member was treating their relative (p = 0.014, OR: 0.43), and about what is meant by "a good death" (p = 0.028, OR: 0.38).
CONCLUSIONS
Our findings suggest that abrupt clinical deterioration is associated with family conflict. Confirming patients' and families' wishes regarding CPR during hospitalization may help reduce family conflict in PCUs.
背景
家庭冲突是姑息治疗中的常见问题，已被确定为提供适当护理的潜在障碍。已有报道一些与家庭冲突相关的人口统计学因素；然而，包括症状、治疗和沟通在内的相关临床因素仍有待阐明。
目的
本研究的目的是确定姑息治疗病房（PCUs）中与家庭冲突相关的症状、治疗和沟通因素。
方法
我们使用了来自一项前瞻性队列研究的已故患者的匹配数据，该研究于2017年1月至2017年12月在日本全国范围内对入住PCUs的癌症患者及其遗属进行了横断面问卷调查。我们使用结果-家庭冲突量表评估家庭冲突。
结果
我们发出了667份问卷，其中443份（66.4%）被返回。我们排除了81名拒绝参与的家庭成员；因此，我们分析了362份（81.7%）回复。死于癌症的患者的平均年龄为73.9±11.3岁，51.9%为男性。多因素逻辑回归显示，患者病情迅速恶化（导致在1-2天内死亡）与关于“善终”含义的家庭冲突之间存在显著关联（p = 0.044，比值比：2.66），以及存在侮辱或对其他家庭成员大喊大叫的家庭成员（p = 0.005，OR：3.22）。此外，还发现住院期间确认家庭对心肺复苏的意愿与关于为其亲属做出医疗决策的家庭冲突（p = 0.013，OR：0.46）、关于成员对待其亲属的方式的家庭冲突（p = 0.014，OR：0.43）以及关于“善终”含义的家庭冲突（p = 0.028，OR：0.38）之间存在显著关联。
结论
我们的研究结果表明，临床状况的突然恶化与家庭冲突有关。在住院期间确认患者及其家庭对心肺复苏的意愿可能有助于减少PCUs中的家庭冲突。
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