病状安定期における終末期医療の選択·意思決定に関する啓発活動―主治医による療養病棟および回復期リハビリテーション病棟での介入効果―

Abstract

We aimed to examine the effectiveness of information provided by a physician to patients and their family in a geriatric rehabilitation unit for facilitating terminal care decision-making process. The subjects were 338 patients who entered our rehabilitation unit between July 2005 and June 2007. Of the 338 patients, we provided terminal care consultation for 224 upon admission. We surveyed the 224 patients who received consultation as well as the 114 patients who did not, and examined the effect of the consultations on decision-making regarding terminal care. In both the intervention and non-intervention groups, approximately half of the patients' families had an opportunity to discuss terminal care prior to entering the hospital. The intervention group, however, had a significantly higher ratio (42.0%) of having the opportunity to discuss terminal care among their family members after leaving the hospital. In the non-intervention group, 31.4% had the knowledge of an artificial respirator and 37.1% tube feeding. This was low compared to the intervention group, among 60% understood both. Among the intervention group, there were many who desired these consultations to be provided far in advance of the critical stage of disease to allow more time to make end-of-life decisions. Furthermore, 60% of the intervention group indicated that the terminal care consultations were effective and useful. In light of these results, physicians should provide terminal care consultations before death is imminent. Since this will encourage self decision-making and help clarify the family's intentions, these kinds of consultations should be more actively implemented.