Effectiveness of Family Care by Reconsidering the Normal Process of Death in Terminal Delirium

2020 Fiscal Year Final Research Report

• Project/Area Number: 17K19875
• Research Category: Grant-in-Aid for Challenging Research (Exploratory)
• Allocation Type: Multi-year Fund
• Research Field: Society medicine, Nursing, and related fields
• Research Institution: National Hospital Organization, Kyushu Cancer Center
• Principal Investigator: Otani Hiroyuki 独立行政法人国立病院機構(九州がんセンター臨床研究センター), その他部局等, 緩和治療科医師 (10600067)
• Co-Investigator(Kenkyū-buntansha): 森田 達也 聖隷クリストファー大学, 看護学研究科, 臨床教授 (70513000)
• Project Period (FY): 2017-06-30 – 2021-03-31
• Keywords: せん妄

Outline of Final Research Achievements

The purpose of this study is to clarify whether care that incorporates the perspective that "terminal delirium" is not a disease but part of the normal process of death (death bed visions) can ease the pain of family members. The purpose of this study is to clarify the following A pilot study in a single-center palliative care ward revealed that medical professionals and family members were resistant to the idea of treating "delirium at the end of life" as a "death bed visions" phenomenon. However, a large-scale fact-finding survey (questionnaire survey) revealed that care that incorporates the perspective that "terminal delirium" is not a disease but part of the normal dying process is appropriate. The feasibility of a randomized trial may not be significantly related to physicians' perceptions, and barriers to interventional trials need to be identified.

Free Research Field

緩和医療

Academic Significance and Societal Importance of the Research Achievements

現在の医学では、「終末期せん妄」のケアは医学的なモデルに基づいて原因の治療と説明と精神的なサポートにとどまっている。しかし、「終末期せん妄」を亡くなる自然の現象としてその患者の体験に肯定的な意味づけをすることによって、医学的に触れてはいけないとされてきたことを、ケアの中核に捉えることで死を看取るという文化の醸成にもつながるかもしれない。次期DSM(精神障害の診断および統計マニュアル)改訂の際は死前の幻覚(超常的な臨死体験)を診断名としての「せん妄(delirium)」ではなく「正常な死の過程」であるという別次元の議論が深まることを期待する。