ターミナルケア : 心療内科の立場から(ターミナルケアと心身医学)(第33回日本心身医学会総会)

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Over the past twelve years, the Terminal Care Study Group at Itabashi Hospital, Nihon University, has been holding a terminal care meeting (TCM) once a month. For the most part, participants report on and discuss cases involving terminal illness. Detailed information about the cases is recorded by a reporter in two formats : one is a TCM case report, and the other is a TCM checkpoint form. Both reports are printed and distributed to the participants of the meeting, where free discussion proceeds among participants under the direction of the chairman. In our discussions of cases, we have often addressed problems associated with terminal care in university hospitals. Most of the 77 patients were 50-60 years old, and most were suffering from lung cancer. The data from the TCM checkpoint forms were summed up and analyzed, and yielded the following results. 57.1% of the subjects had occupations when hospitalized, 11.7% had financial problems, and 11.6% belonged to some kind of religious sect. 11.0% had been properly informed of their disease, and 73.8% felt that communication with their medical care practitioners was satisfactory. Of those who found the communication with medical care practitioners insufficient, some complained of not being informed of the true name of their disease, and others complained that their pain was not being properly controlled. Complaints regarding QOL (quality of life) were summed up as follows. 71.0% complained of meals and related items, 65.2% of insufficiency in excretion, 59.4% of having trouble sleeping, 82.6% of poor sanitation, and 76.8% of insufficient motor function. This strongly suggests that at the terminal phase of disease, it is often difficult to maintain the quality of life to a normal level. 85.9% of the subjects suffered pain, and 23.4% had their pain properly controlled by medical means. 73.9% suffered mental instability, including anxiety, depression, loneliness, irritation, or confusion. 20.1% had problems of social adaptation. Next we transferred our attention from problems related to the patients to requests made by the patients and their family members. The most urgent requests (sought by the patients and their families) was related to pain control. In this study we focused our attention on patients who had been discussed at the TCM on account of their having unique problems, and through the investigation of such patients, we think we could reveal the current status of patients requiring terminal care in university hospitals. Lastly, we indicated a number of points appropriate for counselling with the patients with terminal illness, and touched upon them briefly.
日本心身医学会の論文
1993-01-08

ターミナルケア : 心療内科の立場から(ターミナルケアと心身医学)(第33回日本心身医学会総会)

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