研究者詳細 - 深堀　浩樹

論文 - 深堀　浩樹

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Rebuilding and guiding a care community: A grounded theory of end-of-life nursing care practice in long-term care settings

Nasu K., Sato K., Fukahori H.

Journal of Advanced Nursing （Journal of Advanced Nursing） 76 （ 4 ） 1009 - 1018 2020年04月

ISSN 03092402

Aims: To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. Design: A qualitative study based on grounded theory developed by Corbin and Strauss. Methods: Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. Results: The core category, “guiding the rebuilt care community to assist the dying resident” comprised five categories: “assessing the resident's stage,” “harmonizing care with the dying process,” “rebuilding a care community,“ “helping community members care for the resident,” and “encouraging community members to give meaning.” The participants were described as “traditional village elders“ who were the integral members of the care community, as well as guides who helped and encouraged the community. Conclusion: Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents’ uncertainties and vulnerabilities as well as their cultural backgrounds. Impact: This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

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Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Hirooka K., Nakanishi M., Fukahori H., Nishida A.

Geriatrics and Gerontology International （Geriatrics and Gerontology International） 20 （ 4 ） 354 - 359 2020年04月

ISSN 14441586

Aim: The number of cancer patients with dementia has increased markedly in accordance with aging societies. Cancer patients might receive palliative and end-of-life care to maintain their quality of life; however, the impact of dementia on the quality of death is unexamined in this population. Consequently, we explored the impact of dementia on the quality of death among cancer patients. Methods: Home palliative care staff members completed questionnaires regarding cancer patients’ (n = 508) cognitive status, cancer-related symptoms and quality of death using the good death inventory. Hierarchical regression analyses were carried out for the entire sample and for stratified groups based on the presence of dementia. Results: Of the 508 patients, 156 (30.7%) had dementia. Hierarchical regression analyses revealed that greater quality of death was associated with not having dementia (P < 0.001). Stratified analyses showed that dying at home was related to greater quality of death both in patients with and without dementia. The presence of a primary family caregiver was associated with greater quality of death only in patients with dementia (P < 0.001). Conclusions: Cancer patients with dementia were less likely to achieve a good death than those without. Our results suggest the importance of enhancing end-of-life care discussions with patients and their families, along with developing specific support strategies to enhance the decision-making of cancer patients with dementia and their family members. Geriatr Gerontol Int 2020; 20: 354–359.

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Advance care planning for adults with heart failure

Nishikawa Y., Hiroyama N., Fukahori H., Ota E., Mizuno A., Miyashita M., Yoneoka D., Kwong J.S.W.

Cochrane Database of Systematic Reviews （Cochrane Database of Systematic Reviews） 2020 （ 2 ） 2020年02月

Background: People with heart failure report various symptoms and show a trajectory of periodic exacerbations and recoveries, where each exacerbation event may lead to death. Current clinical practice guidelines indicate the importance of discussing future care strategies with people with heart failure. Advance care planning (ACP) is the process of discussing an individual's future care plan according to their values and preferences, and involves the person with heart failure, their family members or surrogate decision-makers, and healthcare providers. Although it is shown that ACP may improve discussion about end-of-life care and documentation of an individual's preferences, the effects of ACP for people with heart failure are uncertain. Objectives: To assess the effects of advance care planning (ACP) in people with heart failure compared to usual care strategies that do not have any components promoting ACP. Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, Social Work Abstracts, and two clinical trials registers in October 2019. We checked the reference lists of included studies. There were no restrictions on language or publication status. Selection criteria: We included randomised controlled trials (RCTs) that compared ACP with usual care in people with heart failure. Trials could have parallel group, cluster-randomised, or cross-over designs. We included interventions that implemented ACP, such as discussing and considering values, wishes, life goals, and preferences for future medical care. The study participants comprised adults (18 years of age or older) with heart failure. Data collection and analysis: Two review authors independently extracted outcome data from the included studies, and assessed their risk of bias. We contacted trial authors when we needed to obtain missing information. Main results: We included nine RCTs (1242 participants and 426 surrogate decision-makers) in this review. The meta-analysis included seven studies (876 participants). Participants' mean ages ranged from 62 to 82 years, and 53% to 100% of the studies' participants were men. All included studies took place in the US or the UK. Only one study reported concordance between participants' preferences and end-of-life care, and it enrolled people with heart failure or renal disease. Owing to one study with small sample size, the effects of ACP on concordance between participants' preferences and end-of-life care were uncertain (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.91 to 1.55; participants = 110; studies = 1; very low-quality evidence). It corresponded to an assumed risk of 625 per 1000 participants receiving usual care and a corresponding risk of 744 per 1000 (95% CI 569 to 969) for ACP. There was no evidence of a difference in quality of life between groups (standardised mean difference (SMD) 0.06, 95% CI –0.26 to 0.38; participants = 156; studies = 3; low-quality evidence). However, one study, which was not included in the meta-analysis, showed that the quality of life score improved by 14.86 points in the ACP group compared with 11.80 points in the usual care group. Completion of documentation by medical staff regarding discussions with participants about ACP processes may have increased (RR 1.68. 95% CI 1.23 to 2.29; participants = 92; studies = 2; low-quality evidence). This corresponded to an assumed risk of 489 per 1000 participants with usual care and a corresponding risk of 822 per 1000 (95% CI 602 to 1000) for ACP. One study, which was not included in the meta-analysis, also showed that ACP helped to improve documentation of the ACP process (hazard ratio (HR) 2.87, 95% CI 1.09 to 7.59; participants = 232). Three studies reported that implementation of ACP led to an improvement of participants' depression (SMD –0.58, 95% CI –0.82 to –0.34; participants = 278; studies = 3; low-quality evidence). We were uncertain about the effects of ACP on the quality of communication when compared to the usual care group (MD –0.40, 95% CI –1.61 to 0.81; participants = 9; studies = 1; very low-quality evidence). We also noted an increase in all-cause mortality in the ACP group (RR 1.32, 95% CI 1.04 to 1.67; participants = 795; studies = 5). The studies did not report participants' satisfaction with care/treatment and caregivers' satisfaction with care/treatment. Authors' conclusions: ACP may help to increase documentation by medical staff regarding discussions with participants about ACP processes, and may improve an individual's depression. However, the quality of the evidence about these outcomes was low. The quality of the evidence for each outcome was low to very low due to the small number of studies and participants included in this review. Additionally, the follow-up periods and types of ACP intervention were varied. Therefore, further studies are needed to explore the effects of ACP that consider these differences carefully.

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Exploring sociodemographic factors related to practice, attitude, knowledge, and skills concerning evidence-based practice in clinical nursing

Tomotaki A., Fukahori H., Sakai I.

Japan Journal of Nursing Science （Japan Journal of Nursing Science） 17 （ 1 ） 2020年01月

ISSN 17427932

Aim: This study aimed to explore sociodemographic factors related to evidence-based practice (EBP) competency in Japanese nurses in university hospitals. Methods: In March 2016, a survey was distributed to 843 clinical nurses who directly provide nursing care at two university hospitals in Japan. Multiple regression analyses were conducted on data received from 472 nurses using the Evidence-Based Practice Questionnaire (Japanese version). Results: Sociodemographic factors related to EBP competency were experience with conducting nursing research as a part of continuing education, education about EBP, advanced practice certification (certified nurse specialists/certified nurses), and years of experience in clinical nursing. These factors differed across the four subscales of the questionnaire: Practice, Attitude, Knowledge of Research and Practice, and Skills of Research and Practice. Specifically, experience with two or more nursing research activities was significantly positively associated with Attitude and Knowledge/Skills Concerning Research and Practice of EBP, but not related to the implementation of EBP itself. Advanced practice certification was significantly positively associated with Practice and Attitude of EBP. Conclusions: Our study quantitatively identified sociodemographic factors including experience with conducting nursing research and advanced practice certification status that were found to be related to EBP competency and these factors were differently associated with the four subscales of the Evidence-Based Practice Questionnaire (Japanese version). EBP education should depend on nurses' levels of EBP competency, and nursing educators and managers need to be cognizant of their nurses' sociodemographic factors when providing EBP education.

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Absence of relatives impairs the approach of nurses to cardiopulmonary resuscitation in non-cancer elderly patients without a do-not-attempt-resuscitation order: A vignette-based questionnaire study

Higuchi A., Takita M., Yoshii A., Akiyama T., Nemoto T., Nakahira R., Nakajima T., Fukahori H., Tsubokura M., Igarashi R.

Tohoku Journal of Experimental Medicine （Tohoku Journal of Experimental Medicine） 250 （ 1 ） 71 - 78 2020年

ISSN 00408727

A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient’s personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses’ perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses’ beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.

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Developing a Measure of End-of-Life Care Nursing Knowledge for Japanese Geriatric Nurses

Okumura-Hiroshige A., Fukahori H., Yoshioka S., Nishiyama M., Takamichi K., Kuwata M.

Journal of Hospice and Palliative Nursing （Journal of Hospice and Palliative Nursing） 21 （ 4 ） E1 - E9 2019年08月

ISSN 15222179

This study developed an end-of-life (EOL) care nursing knowledge scale for Japanese geriatric nurses (ELNKS-JG) to measure nurse knowledge of EOL care for older adults. It also was used to evaluate the quality of The End-of-Life Nursing Education Consortium-Japan Geriatric. Participants were 1168 nurses employed in 32 institutions across Japan. The items of our measure were developed to cover 8 important topics: principles of EOL care for older adults; pain management; symptom management; ethics of care; cultural and spiritual considerations; communication; loss, grief, and bereavement; and caring for final days. The measure included 51 items with an overall Cronbach coefficient of 0.87 and an intraclass correlation coefficient of 0.81. Our measure, the ELNKS-JG, was confirmed to have good internal consistency, test-retest reliability, content validity, and known-groups validity. This scale's items included knowledge about noncancerous diseases, physical changes due to aging, family care, and multidisciplinary collaboration. The ELNKS-JG comprehensively measures a nurse's knowledge of EOL care for older adults in any EOL setting. Furthermore, this scale can evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

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Posttraumatic growth in bereaved family members of patients with cancer: a qualitative analysis

Hirooka K., Fukahori H., Taku K., Izawa S., Ogawa A.

Supportive Care in Cancer （Supportive Care in Cancer） 27 （ 4 ） 1417 - 1424 2019年04月

ISSN 09414355

Background: The death of a loved one has great impact on family members even when the death was expected. While negative changes are reported, some individuals also report personal growth, known as posttraumatic growth (PTG). Many studies on PTG have been performed using quantitative methods and suggest that PTG may differ according to the traumatic event and cultural background. Purpose: This study aimed to explore how Japanese bereaved family members of patients with cancer express their experience of PTG after the patient’s death by analyzing open-ended answers provided in a cross-sectional survey. Methods: Qualitative data were collected through a survey, and thematic analysis was used to analyze the data. The present study was part of a larger cross-sectional survey of bereaved families of patients with cancer. Data analyzed in the current study were obtained from 162 bereaved family members of patients with cancer. Results: We identified 18 sub-themes within five predefined major domains of PTG. Moreover, we also identified two additional themes: changed view of life and death, and awareness of health management. Conclusions: The experience of PTG of bereaved family members varied considerably. Future research on PTG experiences among groups from diverse cultural backgrounds would be beneficial for understanding the concept and its clinical implications.

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Factors associated with depressive symptoms in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective cohort study

Doi M., Fukahori H., Oyama Y., Morita K.

Nursing Open （Nursing Open） 5 （ 4 ） 583 - 592 2018年10月

Aim: To identify the association between possible factors and depression among post-percutaneous coronary intervention patients with acute coronary syndrome. Design: Prospective cohort study. Methods: Sixty-eight post-percutaneous coronary intervention patients with acute coronary syndrome were enrolled between January 2016 - June 2017. The Hospital Anxiety and Depression Scale scores at 1–3 months after discharge were regressed onto uncertainty in illness and other clinical factors based on the Roy Adaptation Model. Results: Thirty-six patients were included in the final analysis. Higher baseline depression scores, higher changes in uncertainty in illness and feeling annoyed by troublesome tasks after discharge were associated with higher depressive scores at 1 month after discharge. Careful observation and support of patients’ ineffective responses in self-concept mode may be effective in preventing depression.

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調査報告分娩後出血のリスク因子のエビデンスの提示に対する臨床看護職の評価　Evidence Based Practiceの促進を目指した調査

比佐, 加奈子, 角川, 綾菜, 中西, 愛海, 廣山, 奈津子, 岩崎, 弓子, 山縣, 千尋, 小笹, 由香 and 深堀, 浩樹

看護管理 28 （ 8 ） 694 - 701 2018年08月

ISSN 0917-1355

＜文献概要＞はじめに　Evidence-Based Practice(EBP)とは,「研究によるエビデンスと,臨床現場の専門能力,患者や家族の価値観を統合させ,協働で意思決定を行う過程」と定義され,看護領域での促進が望まれる。米国では臨床の実践者が主体のEBP促進のモデルとしてIOWAモデルがあり,活用例として開腹手術後の腸蠕動音聴取の取りやめや,手術時の手袋の二重装着の促進がある。しかし,日本の看護領域ではEBPは十分には普及していない。EBPの個人的バリアには,研究に価値を感じないなどの「価値観」,文献検索能力の不足などの「スキル」の側面がある。また,組織的バリアとして時間不足,情報検索ツールへのアクセスや,英文献の読解という言語的な壁も指摘されている。本調査ではこれらの阻害要因への対応となりうる活動として,学生のEBPプロジェクトが職員・学生の学習や大学と臨床現場の協働を促進する可能性に着目し,看護系大学の学部学生・教員・大学院生らが,文献の系統的検索,質の評価,結果の統合を行い,まとめたエビデンスを臨床看護職に提示する活動(便宜的にこの一連の活動をEBP活動と呼称する。この活動はEBPの促進を目的としたもので看護実践は含まない)を行い,その活動への看護職の評価を明らかにすることを目的とした。本調査から日本におけるEBP促進の示唆が得られることが期待される。

山縣, 千尋, 西川, 裕理, 奥村, 朱美, 那須, 佳津美 and 深堀, 浩樹

日本臨床 76 （増刊7 老年医学(下) ） 711 - 716 2018年08月

ISSN 0047-1852

意外に知られていない高齢者の事故　本当は怖い○○の話(第8回)　本当は怖い"ベッド柵"の話

深堀, 浩樹

看護技術 64 （ 9 ） 897 - 901 2018年08月

ISSN 0449-752X

Development of the End-of-Life Care Nursing Attitude Scale for Japanese Geriatrics

Okumura-Hiroshige A., Fukahori H., Yoshioka S., Kuwata M., Nishiyama M., Takamichi K.

Journal of Hospice and Palliative Nursing （Journal of Hospice and Palliative Nursing） 20 （ 3 ） 272 - 278 2018年06月

ISSN 1522-2179

This study aimed to develop an end-of-life (EOL) care nursing attitude scale for Japanese geriatric nurses (ELNAS-JG). The items of the ELNAS-JG were developed to cover important topics related to EOL care (eg, motivation for providing EOL care, pain and symptom management, and decision-making support care for older adults). Participants were 1663 nurses employed in 32 institutions across Japan. Of these, 1298 participants were analyzed. An exploratory factor analysis of the 26 scale items revealed a 3-factor solution describing the concepts of responsibility, willingness, and confidence: responsibility and willingness were captured in factor 1 (16 items), and confidence was split into factor 2 (6 items) and factor 3 (4 items) to capture individual and collaborative behaviors. The overall Cronbach α coefficient for the 26 items was 0.95, and the intraclass correlation coefficient was 0.83. Overall, the ELNAS-JG was confirmed to have good internal consistency, test-retest reliability, content validity, known-groups validity, and construct validity. It can comprehensively measure nurses' attitudes toward EOL care for older adults in any EOL setting. Furthermore, this scale can be used to evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

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Advance care planning for heart failure

Nishikawa Y., Fukahori H., Ota E., Mizuno A., Hiroyama N., Miyashita M., Yoneoka D., Kwong J.S.W.

Cochrane Database of Systematic Reviews （Cochrane Database of Systematic Reviews） 2018 （ 5 ） 2018年05月

ISSN 1361-6137

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Evidence Based Practiceのための入院患者へのせん妄ケアに関する文献検討

瀬戸, 菜月, 川崎, 翔太, 前田, 夏咲, 西川, 裕理, 山縣, 千尋, 戸田, あゆみ, 廣山, 奈津子, 長尾, 祥子, 田村, 貴子 and 深堀, 浩樹

看護技術 64 （ 6 ） 81 - 87 2018年05月

ISSN 0449-752X

入院患者への看護師によるせん妄ケアのエビデンスをシステマティックレビュー、ランダム化比較試験(RCT)、ガイドライン、書籍・雑誌記事、質的研究の文献検討により収集し、統合することを目的に、Cochrane Library、医学中央雑誌Web版、PubMedなどを用い検索を行い、得られたわが国の看護師に適用可能と判断したシステマティックレビュー1件、RCT6件、ガイドライン10件、書籍・雑誌記事3冊、質的研究4件を分析した。その結果、システマティックレビューでは多職種による多面的介入がせん妄の発症を減少させる中程度のエビデンスが示され、個々のRCTでは、多職種による介入の具体的な内容がまとめられていたが、わが国で行われたRCTが存在しないことから、これらの多面的介入に含まれる内容から、各々の実践現場で適用可能な内容を選択し、多職種と連携しながら行っていくことが望ましいと考えられた。

The development and validation of the Evidence-Based Practice Questionnaire

Tomotaki Ai, Fukahori Hiroki, Sakai Ikuko, Kurokohchi Kana

International Journal of Nursing Practice 24 （ 2 ） 2018年04月

ISSN 1322-7114

<p>Aim: To develop and test the validity and reliability of a Japanese version of the Evidence-Based Practice Questionnaire. Methods: The Evidence-Based Practice Questionnaire was translated into Japanese, and a back-translation was performed. In March 2016, the survey was conducted among 843 nurses in 2 university hospitals in Japan. After 2 weeks, the same questionnaire for test-retest reliability was distributed to 197 nurses. We evaluated construct validity by factor analysis: convergent, discriminant, criterion-based and known-group validity, and reliability (internal consistency via Cronbach' alpha and test-retest reliability). Results: A total of 533 (66%) of nurses who agreed to our study returned the completed questionnaire, and 108 nurses (55%) agreed to the test-retest. Factor analysis confirmed that the original model of the Evidence-Based Practices Questionnaire was not statistically appropriate for Japanese nurses. Therefore, the final version of the Japanese version adopted 18 items and 4 subscales including practice, attitudes, and knowledge/skills related to research and practice. In the final version, the validity and reliability were moderate (Cronbach alpha =.90). Conclusion: The Japanese version of the Evidence-Based Practices Questionnaire is a reliable and valid tool and can be used to assess evidence-based practice, attitudes, and research knowledge/skills in Japan.</p>

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The development and validation of the Evidence-Based Practice Questionnaire: Japanese version

Tomotaki A., Fukahori H., Sakai I., Kurokohchi K.

International Journal of Nursing Practice （International Journal of Nursing Practice） 24 （ 2 ） 2018年04月

ISSN 13227114

Aim: To develop and test the validity and reliability of a Japanese version of the Evidence-Based Practice Questionnaire. Methods: The Evidence-Based Practice Questionnaire was translated into Japanese, and a back-translation was performed. In March 2016, the survey was conducted among 843 nurses in 2 university hospitals in Japan. After 2 weeks, the same questionnaire for test-retest reliability was distributed to 197 nurses. We evaluated construct validity by factor analysis: convergent, discriminant, criterion-based and known-group validity, and reliability (internal consistency via Cronbach' alpha and test-retest reliability). Results: A total of 533 (66%) of nurses who agreed to our study returned the completed questionnaire, and 108 nurses (55%) agreed to the test-retest. Factor analysis confirmed that the original model of the Evidence-Based Practices Questionnaire was not statistically appropriate for Japanese nurses. Therefore, the final version of the Japanese version adopted 18 items and 4 subscales including practice, attitudes, and knowledge/skills related to research and practice. In the final version, the validity and reliability were moderate (Cronbach alpha =.90). Conclusion: The Japanese version of the Evidence-Based Practices Questionnaire is a reliable and valid tool and can be used to assess evidence-based practice, attitudes, and research knowledge/skills in Japan.

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米国在住の日本人看護職者の留学の理由と準備　インターネットによる横断的調査

小林, 桃子, 佐藤, 可奈, 原田, 奈穂子, 足立, 彩花 and 深堀, 浩樹

お茶の水看護学雑誌 12 （ 1-2 ） 16 - 24 2018年03月

ISSN 1881-2112

Examining Posttraumatic Growth Among Bereaved Family Members of Patients With Cancer Who Received Palliative Care at Home

Hirooka K., Fukahori H., Taku K., Togari T., Ogawa A.

American Journal of Hospice and Palliative Medicine （American Journal of Hospice and Palliative Medicine） 35 （ 2 ） 211 - 217 2018年02月

ISSN 1049-9091

Objective: The present study examines the factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J) among bereaved family members who lost loved ones to cancer after home-based palliative care in Japan. It evaluates the relationships between total score, each PTGI-J domain, and participants’ having a religious belief, gender, age, relationship to the patient, and time since patient death. Procedure: Bereaved family members (n = 849) completed the PTGI-J and a demographic questionnaire. The factor structure was tested using confirmatory factor analysis (CFA), and univariate analysis was used to test hypotheses. Results: Confirmatory factor analysis showed that the current sample moderately fitted to both 4-factor and 5-factor models. Univariate analysis revealed that having a religious belief and gender were associated with all domains and total PTGI-J score. Age, time since patient death, and relationship to the patient showed significant differences with the domains of PTGI-J. Conclusion: Clinicians may be able to adjust the support they provide based on patients’ personal characteristics. Future research should look at the mechanisms of PTG by examining the role of rumination, social support, and emotional distress among bereaved family members of patients with cancer.

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【認知症ケアプロセスの可視化　「認知症ケア加算」がもたらした成果と展望】認知症ケア加算の影響と今後の展望　認定看護師,専門看護師を対象としたWeb調査と結果から

深堀, 浩樹, 森山, 祐美, 石川, 容子, 酒井, 郁子 and 日本老年看護学会老年看護政策検討委員会

看護管理 28 （ 2 ） 109 - 113 2018年02月

ISSN 0917-1355

End-of-life experiences of family caregivers of deceased patients with cancer

Hirooka Kayo, Otani Hiroyuki, Morita Tatsuya, Miura Tomofumi, Fukahori Hiroki, Aoyama Maho, Kizawa Yoshiyuki, Shima Yasuo, Tsuneto Satoru, Miyashita Mitsunori

Psycho-Oncology 27 （ 1 ） 272 - 278 2018年01月

ISSN 1057-9249

<p>Objectives: The purpose of this study was (a) to describe the end-of-life experience of family caregivers of cancer patients, (b) to describe talking about death and dying of the patient to minor children, and (c) to examine the association of family caregivers' experiences by their characteristics and talking about death and dying of the patient. Methods: A cross-sectional nationwide survey of bereaved family caregivers was conducted. In total, 968 questionnaires were sent to bereaved family caregivers, and 711 were completed and returned. Fifty-three responses indicating patients had minor children were analyzed. Univariate analysis and principal component analysis were performed. Results: Family caregivers' experiences were divided into 3 domains by principal component analysis: protect children from the patient's imminent death, little regard for the children, and worry and concern about the children's emotional reaction. Family caregivers' common experiences were as follows: “I wanted to know how the children felt,” “I wanted to avoid making the children confused,” and “I did not have much time to talk with and/or play with the children.” About 30% of family caregivers reported that they “did not talk” about death and dying of patients to minor children. Spouses of patients and family caregivers who did not talk about death tended to experience distress and worry. Conclusions: Most family caregivers experienced worry and fear regarding minor children's emotional reaction; therefore, clinicians need to explain children's emotional and psychological reactions to family caregivers when a patient is at the end-of-life.</p>

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