Advance care planning in patients with serious illness

2022 Fiscal Year Final Research Report

• Project/Area Number: 16K08878
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Medical sociology
• Research Institution: Nagoya City University
• Principal Investigator: Okuyama Toru 名古屋市立大学, 医薬学総合研究院(医学), 教授 (80349349)
• Project Period (FY): 2016-04-01 – 2023-03-31
• Keywords: がん / 精神腫瘍学 / 緩和ケア / アドバンスケアプランニング / QOL / 抑うつ / インフォームドコンセント

Outline of Final Research Achievements

We conducted a multicenter, collaborative, longitudinal observational study among 200 patients with advanced lung cancer and their caregivers. Results showed that: 1) 54% and 44% of patients correctly understood that their cancer was incurable and that the goal of chemotherapy was not to completely cure the cancer, respectively; 2) patients who were explained the repeatedly incurable nature of their cancer demonstrated a more accurate understanding of their prognosis compared to those who were only explained once; 3) patients with accurate prognostic understanding had a significantly lower preference for life-prolonging treatments; and 4) the presence or absence of discussions regarding end-of-life care was not associated with patients' quality of life, depression, or actual end-of-life care. Based on the results of this study, the importance of conducting iterative and ongoing end-of-life discussions has been suggested.

Free Research Field

精神医学

Academic Significance and Societal Importance of the Research Achievements

我が国において、重い病気にかかった際、予め医療者と患者さんが終末期における過ごし方について話し合った方が良いのかどうかは明らかになっていません。
200名の進行がん患者さんとそのご家族を対象とした調査の結果、医療者と患者さんが病状や終末期について話し合うことは、短期的には患者さんがご自身の病気をよく理解し、延命治療の希望が減るなどの意義があるものの、実際の終末期ケアには大きな影響を及ぼしていませんでした。
終末期におけ過ごし方とは、病の経過の中で1回のみ行うというよりは反復して実施し、その時々の患者さん・ご家族の意向に応じてケアを計画していくことが必要と思われることが示唆されました。