2019 Fiscal Year Final Research Report

Development of a Japanese style advance care planning model for people with chronic illnesses to be practiced by interdisciplinary care providers

Research Project

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Project/Area Number	16H05582
Research Category	Grant-in-Aid for Scientific Research (B)
Allocation Type	Single-year Grants
Section	一般
Research Field	Clinical nursing
Research Institution	Japanese Red Cross College of Nursing
Principal Investigator	MORITA Minako 日本赤十字看護大学, 看護学部, 教授 (50288065)
Co-Investigator(Kenkyū-buntansha)	樋口佳栄日本赤十字看護大学, 看護学部, 講師 (00460098) 田中孝美日本赤十字看護大学, 看護学部, 准教授 (60336716) 本庄恵子日本赤十字看護大学, 看護学部, 教授 (70318872) 吉田みつ子日本赤十字看護大学, 看護学部, 教授 (80308288) 中村光江日本赤十字九州国際看護大学, 看護学部, 教授 (80381466)
Project Period (FY)	2016-04-01 – 2020-03-31
Keywords	ACP / 慢性疾患 / 多職種連携 / 日本型 / アドバンス・ケア・プランニング
Outline of Final Research Achievements	Patients who have chronic illnesses (cardiac insufficiency, respiratory insufficiency, and/or renal insufficiency) suffer a prolonged progress with the development of an illness difficult to foresee. Implementing ACP, therefore, will involve a number of challenges. We conducted a survey targeting doctors and nurses,831 in total,as well as interviews with 39 doctors and nurses who are working on chronic illnesses treatment. We created a care model based on the four elements identified by the survey and interviews: 1) Care providers’ understanding of the experiences of chronic illnesses and dialogue with the patient; 2) patients choosing how to live not just choosing the type of final treatment; 3) the appropriate professional takes the lead depending on the needs of the patients and their families; and 4) initial hesitation to talk about death then decisions are made with trusted relationships. We also created a practical ACP implementation guidebook covering the three fields.
Free Research Field	緩和ケア
Academic Significance and Societal Importance of the Research Achievements	日本では高齢者や終末期等に対するACPの報告はあるが、慢性疾患患者を対象にしたACPの実践に関する研究は少ない。その人らしく生きることを支えるACPの考えを基軸に、家族や医療チームとの関係性の中で共に考え決めていく意思決定を実現する今回のケアモデルは、慢性疾患患者と家族の特性に応じたACPのケアモデルであると考えている。さらにガイドブックは、多くの専門家の意見に基づき作成したものであるため、日本でACPを実践する上で有用であり、実践面だけでなく医療者への教育など教育的な意義もあると考える。