Hirahara S, Kanda M, Nishimoto A, Hozumi T, Nakamura M, Hirahara Y, Takahashi K, Hijiya S
Dept. of Internal Medicine, Tokyo Fureai Medical Co-operation.
Gan To Kagaku Ryoho. 1994 Dec;21 Suppl 4:521-6; discussion 527.
On the basis of investigations of 15 patients from our clinic with terminal cancer who were treated by home hospice care, and questionnaires filled out by their caretakers, we examined the current status and problems of the home hospice care system with respect to four phases, namely, the period of preparation for home care (hospitalization period), stable period, terminal period, and the period immediately before death. [Preparation period] The following problems occurred in this phase: introduction of pain management and nutrition management was insufficient; there were only a few cases in which the patient chose home care of his or her own will; and sufficient instructions were not given to caretakers on discharge from the hospital, with respect to medical treatment at home. [Stable period] In two of the four cases in which patients complained of severe pain, the pain was not alleviated because pain management was provided only at the outpatient clinics of the hospital, and collaboration between hospitals and our clinic was insufficient. [Terminal period] Two patients could not be admitted to the hospital upon sudden exacerbation of the condition, suggesting the need to establish a system in which large hospitals can cope with sudden exacerbation of their condition of patients with terminal cancer treated at home. [Period immediately before death] Of the 14 patients who died, 7 died at home and 7 died in the hospital or during transport to the hospital. Three subjects died within a few days after admission. Two of the subjects who died in the hospital or during transport had hoped to stay home until the last moment. Further improvement of the system is necessary in order to meet the needs of terminal cancer patients who wish to die at home. On the basis of the cases taken care of at our clinic, we examined the home care system according classification into three types; hospital-outpatient clinic type; hospital-home care type; and clinic-home care type. An ideal system for the treatment of patients with terminal cancer who hope to stay at home until the last possible moment seems to be the clinic-home care type in which a primary care team that is able to dispatch physicians and nurses, and an around-the-clock support system, are supported by outside organizations and specialists.
基于对我院15例接受居家临终关怀治疗的晚期癌症患者的调查以及其护理人员填写的问卷，我们从四个阶段，即居家护理准备期（住院期）、稳定期、终末期以及临终前阶段，审视了居家临终关怀护理系统的现状与问题。[准备期] 此阶段出现了以下问题：疼痛管理和营养管理的引入不足；患者出于自身意愿选择居家护理的情况较少；出院时未就居家医疗对护理人员给予充分指导。[稳定期] 在4例主诉剧痛的患者中，有2例疼痛未得到缓解，原因是仅在医院门诊进行疼痛管理，且医院与我院之间的协作不足。[终末期] 2例患者病情突然加重时无法入院，这表明需要建立一个系统，使大型医院能够应对在家接受治疗的晚期癌症患者病情突然加重的情况。[临终前阶段] 在14例死亡患者中，7例在家中死亡，7例在医院或送往医院途中死亡。3例患者在入院后几天内死亡。在医院或送往医院途中死亡的2例患者曾希望在家中待到最后一刻。为满足希望在家中离世的晚期癌症患者的需求，有必要进一步完善该系统。基于我院护理的病例，我们将居家护理系统分为三种类型进行审视：医院 - 门诊型；医院 - 居家护理型；以及诊所 - 居家护理型。对于希望在家中待到最后一刻的晚期癌症患者而言，理想的治疗系统似乎是诊所 - 居家护理型，即由一个能够派遣医生和护士的初级护理团队以及一个全天候支持系统，并得到外部组织和专家的支持。
