2022 Fiscal Year Final Research Report

Best evidence project on guideline development with multiple evidence end of life care in older people with dementia

Research Project

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Project/Area Number	17K12440
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Research Field	Gerontological nursing
Research Institution	Hyogo Medical University (2022) Hyogo University of Health Sciences (2018-2021) Kansai University of International Studies (2017)
Principal Investigator	Konno RIe 兵庫医科大学, 看護学部, 教授 (10341372)
Co-Investigator(Kenkyū-buntansha)	日野徳子関西国際大学, 保健医療学部, 講師 (60775047) 山川みやえ大阪大学, 大学院医学系研究科, 准教授 (80403012) 伴美由紀兵庫大学, 看護学部, 助手 (20780919) 牧本清子甲南女子大学, 看護リハビリテーション学部, 客員研究員 (80262559) 松下由美子甲南女子大学, 看護リハビリテーション学部, 教授 (50331806) 井上久美代関西国際大学, 保健医療学部, 教授 (70848291) 酒井啓子畿央大学, 健康科学部, 講師 (70880839)
Project Period (FY)	2017-04-01 – 2023-03-31
Keywords	dementia / advance care planning / end of life / umbrella review / qualitative synthesis / thematic synthesis
Outline of Final Research Achievements	Evidence on advance care planning (ACP) for older adults with dementia was examined using an umbrella review methodology. Since the method of qualitative-umbrella synthesis was undeveloped, we considered the opinions of national and international experts and professional associations and applied the Thematic Synthesis method. In total,16 descriptive themes and 5 analytic themes were obtained from four qualitative reviews (38 primary studies): 1) making the wishes/preferences of persons with dementia visible; 2) constructive collaboration based on stakeholders having positive relationships; 3) emotional chaos in facing end-of-life substitute decision-making; 4) initiating the advanced care planning process; and 5) preparedness and commitment of healthcare providers to advanced care planning.　Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.
Free Research Field	老年看護学
Academic Significance and Societal Importance of the Research Achievements	EoLケア全体でなくACPに焦点を絞ったこと、質的エビデンスを対象としたアンブレラレビュー手法を採用したことで、実践へ示唆に富んだ厳密で質の高いエビデンス構築ができた。特に認知症をもつ高齢者とその家族にとってACPは今なお敬遠されるテーマであり、医療者や介護者との信頼関係がACPの前提となること、本人の意思をくみ取ろうとする医療者の努力、家族の貢献や苦悩についてのエビデンスも明らかになった。また、本プロジェクトではThematic synthesis手法を取り入れアンブレラ統合を導き出すことができた。今後、増加する質的レビューの統合に方法論上の一つの方向性を示すことができたと考える。