| Project/Area Number |
18K17320
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| Research Category |
Grant-in-Aid for Early-Career Scientists
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| Allocation Type | Multi-year Fund |
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| Review Section |
Basic Section 58010:Medical management and medical sociology-related
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| Research Institution | Kyoto University |
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Principal Investigator |
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| Project Period (FY) |
2018-04-01 – 2024-03-31
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| Project Status |
Completed (Fiscal Year 2023)
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| Budget Amount *help |
¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000)
Fiscal Year 2020: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2019: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
Fiscal Year 2018: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
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| Keywords | palliative care / advanced care planning / Intensive Care / decision-making / ICU / ACP / Advancaed care planning / Intensive care / end of life care / decision making / country comparison / End-of-life care / intensive care / interviews / health expertise / advance care planning / decision- making / palliative / clinical care |
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| Outline of Final Research Achievements |
Two phases: 1. A systematic review in relation to End-of-life care in ICU, with a focus on communication and decision-making across countries. 2. Interviews with clinicians and academics in UK and Japan, to identify attitudes about advanced care planning (ACP) and its use in the intensive care (ICU) context. We generated international evidence, which demonstrated that when palliative care was integrated in the intensive care, better outcomes were found with regards to family communication and decision-making, alongside ACP implementation. The interviews revealed that both countries are considering the importance of ACP in ICU, but gave a different focus, reflecting differences in cultural values. Patient autonomy(UK) vs patient dignity (Japan) and patient-centered (UK) vs family-centered (Japan) decision-making were some of the key differences. Determining patient capacity was perceived fundamental by UK clinicians, whilst family's wishes took priority by JP clinicians.
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| Academic Significance and Societal Importance of the Research Achievements |
これは、アドバンス・ケア・プランニングに関して英国と日本を比較した初めての研究である。レビューの結果、個々のICUの文化、ACPのトレーニング、緩和ケアチームの関与が、それぞれの病棟におけるACPの取り組みと実践のばらつきに影響しているようである。インタビューでは、両国とも患者の苦痛を和らげたいと考えているが、英国の臨床家は「患者の最善の利益」を優先し、日本の臨床家は家族の満足を優先していることが明らかになった。したがって、異なる国でアドバンス・ケア・プランニングを実施する際には、文化的背景と社会の価値観を理解することが重要である。
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