在宅療養移行時の病診連携と急性期病院医師の課題

終未期患者が療養の場所として自宅を選択する場合に,急性期病院(急性期)から地域医療機関(地域)医師へのスムーズな移行のために,どのような課題があるかを明らかにし,今後の急性期と地域医師連携に役立てるために,医師対象のアンケート調査を行った.アンケート項目は(1)属性,(2)患者家族への病状説明,告知の問題,(3)患者家族の不安について,(4)病診連携等,などであり,アンケート配布数185,回答数は123(急性期医師35,地域医師は88)で回収率は67%であった.アンケート結果は,急性期医師の43%が告知に関して「家族の希望に沿う」と回答し,85%は「患者家族の病状理解ができている」と回答している.一方,地域医師の「患者家族の病状理解ができている」は58%で「急性期からの申し送り内容と患者家族の病状理解が一致している」と回答した地域医師は約50%にすぎなかった.そして,急性期,地域医師たちの多くは患者へ余命告知がされていないこと,患者家族の病状理解が不十分であることに起因する対応困難を感じていた.安心な在宅医療,療養生活のために,急性期医師が整理すべき重要な課題として,患者家族に対しての告知,病状説明や在宅医療へ移行時の医療連携があげられる.具体的には,(1)急性期医師がコミュニケーションスキルを獲得すること,(2)患者にとっては生活の場である在宅での医療の視点で連携ができること,さらに(3)院内外の他職種とのチーム医療をリードできることが必要と考えられる.We conducted a survey to clarify issues related to a smooth transition from a hospital which providing medical treatment at an acute stage (abbreviated as "acute care")to a home care setting (abbreviated as "community") when a cancer patient at a terminal stage selects his/her home as the place of medical treatment. The items included in the questionnaires were (1) demographic data, (2) informed consent, (3) anxiety of a patient/family, and (4) coordination. We compared with the situations of home care setting and acute care hospitals. Questionnaires of 185 were distributed and 123 (35 from acute doctors, 88 from community doctors) were returned. The response rate was 67%. The acute care doctors of 43% responded that "they will go along with the family's wish" with regard to the issue of informing, and 85% responded that "the patient/family understands the medical condition". On the other hand, 58% of the community doctors responded that "the patient/family understands the medical condition", and only about 50% of the community doctors responded that "the description of the medical condition provided by the acute doctor and the level of understanding of the medical condition by the patient's family is consistent". Both the acute care and community doctors experienced difficulty dealing with a patient/family because they did not inform the patient about their life expectancy and because the patient' s family did not understand enough about the medical condition. Acute care doctors need to assure a sense of security for patients allow both a smooth transition to a home care setting from a hospital. These issues include informing the patient/family, explaining the medical condition, and cooperating with the community doctors' at the time of transition to home care. For that purpose, acute doctors need to acquire the necessary communication skill so that they can properly provide informed consent, can cooperate with the community doctors and can lead group activities in a medical team

在宅療養移行時の病診連携と急性期病院医師の課題

終未期患者が療養の場所として自宅を選択する場合に,急性期病院(急性期)から地域医療機関(地域)医師へのスムーズな移行のために,どのような課題があるかを明らかにし,今後の急性期と地域医師連携に役立てるために,医師対象のアンケート調査を行った.アンケート項目は(1)属性,(2)患者家族への病状説明,告知の問題,(3)患者家族の不安について,(4)病診連携等,などであり,アンケート配布数185,回答数は123(急性期医師35,地域医師は88)で回収率は67%であった.アンケート結果は,急性期医師の43%が告知に関して「家族の希望に沿う」と回答し,85%は「患者家族の病状理解ができている」と回答している.一方,地域医師の「患者家族の病状理解ができている」は58%で「急性期からの申し送り内容と患者家族の病状理解が一致している」と回答した地域医師は約50%にすぎなかった.そして,急性期,地域医師たちの多くは患者へ余命告知がされていないこと,患者家族の病状理解が不十分であることに起因する対応困難を感じていた.安心な在宅医療,療養生活のために,急性期医師が整理すべき重要な課題として,患者家族に対しての告知,病状説明や在宅医療へ移行時の医療連携があげられる.具体的には,(1)急性期医師がコミュニケーションスキルを獲得すること,(2)患者にとっては生活の場である在宅での医療の視点で連携ができること,さらに(3)院内外の他職種とのチーム医療をリードできることが必要と考えられる.We conducted a survey to clarify issues related to a smooth transition from a hospital which providing medical treatment at an acute stage (abbreviated as "acute care")to a home care setting (abbreviated as "community") when a cancer patient at a terminal stage selects his/her home as the place of medical treatment. The items included in the questionnaires were (1) demographic data, (2) informed consent, (3) anxiety of a patient/family, and (4) coordination. We compared with the situations of home care setting and acute care hospitals. Questionnaires of 185 were distributed and 123 (35 from acute doctors, 88 from community doctors) were returned. The response rate was 67%. The acute care doctors of 43% responded that "they will go along with the family\u27s wish" with regard to the issue of informing, and 85% responded that "the patient/family understands the medical condition". On the other hand, 58% of the community doctors responded that "the patient/family understands the medical condition", and only about 50% of the community doctors responded that "the description of the medical condition provided by the acute doctor and the level of understanding of the medical condition by the patient\u27s family is consistent". Both the acute care and community doctors experienced difficulty dealing with a patient/family because they did not inform the patient about their life expectancy and because the patient\u27 s family did not understand enough about the medical condition. Acute care doctors need to assure a sense of security for patients allow both a smooth transition to a home care setting from a hospital. These issues include informing the patient/family, explaining the medical condition, and cooperating with the community doctors\u27 at the time of transition to home care. For that purpose, acute doctors need to acquire the necessary communication skill so that they can properly provide informed consent, can cooperate with the community doctors and can lead group activities in a medical team