2021 Fiscal Year Final Research Report

Survey on quality of end-of-life care and place of death by using nationwide administrative data

Research Project

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Project/Area Number	18H03082
Research Category	Grant-in-Aid for Scientific Research (B)
Allocation Type	Single-year Grants
Section	一般
Review Section	Basic Section 58060:Clinical nursing-related
Research Institution	Nagoya University
Principal Investigator	Sato Kazuki 名古屋大学, 医学系研究科(保健), 准教授 (60583789)
Co-Investigator(Kenkyū-buntansha)	宮下光令東北大学, 医学系研究科, 教授 (90301142) 坂下明大神戸大学, 医学部附属病院, 医学研究員 (90514662) 田辺公一名城大学, 薬学部, 准教授 (30709704) 安藤詳子名古屋大学, 医学系研究科(保健), 教授 (60212669) 杉田豊子名古屋大学, 医学系研究科(保健), 助教 (10454373)
Project Period (FY)	2018-04-01 – 2021-03-31
Keywords	緩和ケア / 終末期医療 / 医療の質 / 実態調査 / ビッグデータ
Outline of Final Research Achievements	We clarified the actual conditions of terminal care and life of non-cancer patients in Japan from NDB sampling dataset and vital statistics. The high level of life-prolonging treatment administered at the end of life of a chronic disease is considered excessive medical care. Life-prolonging treatment was more common for non-cancer diseases compared to cancer. This was particularly common in heart failure, but the mix of acute and chronic disease was a challenge in the evaluation. Palliative treatment was very infrequent outside of cancer. Home deaths show no upward trend for any cause of death other than cancer. Analysis by medical region also showed that only a few medical regions showed an increase in home deaths for causes of death other than cancer.
Free Research Field	緩和ケア
Academic Significance and Societal Importance of the Research Achievements	高齢多死社会を迎え、終末期医療の質の保障は重要な課題である。本邦では緩和ケアはがん医療を中心に発展し、非がん疾患での終末期ケアが特に課題となる。医療ビッグデータであるレセプトや死亡診断書の情報を研究目的で活用し、非がん終末期ケアの実態を明らかにした。がんと比較して非がん疾患では終末期に、過剰な延命治療が多く、症状緩和治療は少ないこと、自宅死亡はがんのみで増加傾向であることが明らかとなった。なお、慢性疾患終末期の延命治療は予後延長効果に比して苦痛が多く推奨されず、終末期の自宅療養は多くの国民の希望である。