Research on promotion of region-based pathway for quality improvement of Home-Based Palliative Care: A Cohort Study

2018 Fiscal Year Final Research Report

• Project/Area Number: 16K19308
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: General internal medicine(including psychosomatic medicine)
• Research Institution: University of Fukui
• Principal Investigator: Kodama Maiko 福井大学, 学術研究院医学系部門(附属病院部), 特命助教 (50464079)
• Research Collaborator: Morita Tatsuya ; Tanabe Kouichi
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: 在宅緩和ケア / 地域連携パス / がん終末期

Outline of Final Research Achievements

In the terminal cancer patients who receive home-based palliative care, 200 cases of Hokuriku 3 prefecture joint regional alliances pathway use group and 49 cases of non-use group were registered. The patient's background; gender, the patient's and family's preferred death place, whether the medical institution responsible for home palliative care was a home care support clinic, the primary site, residence and pass start medical institution, showed significant differences between 2 groups(p <0.05). The results showed no significant difference in the rate of home death and in the QOD of patients in the pathway use and non-use groups. In order to promote the spread of the pathway, we visited the hospitals, clinic, and visit nursing stations, and held pass explanations and a multi-job type collaborative workshop twice a year. The Home Palliative Care Promotion Conference was held twice a year to discuss issues in regional palliative care. I made a homepage to get a pass when needed.

Free Research Field

緩和医療

Academic Significance and Societal Importance of the Research Achievements

本研究で、北陸三県合同在宅緩和ケア地域連携パス使用例は200例登録され、一定の普及効果を認めた。非使用群との比較で在宅死亡率、患者の死亡前QOLに有意差はなかった。今後パス使用群において既存ツール使用の有無を担当看護師から聴取し、除外することでパスの効果を明らかにできる可能性がある。パス使用後アンケート結果から「教育ツールになる」「患者医療者間のつながりを強める」等の有用性が明らかになった。「リアルタイムでの情報共有が困難であること」「パス記入に負担があること」「パス自体の入手が困難であること」等デメリットも明らかとなり、今後はパスの媒体を紙ベースからICTネットワーク型へ移行も検討する。