終末期にある高齢患者の意思の尊重について—東京都の病院看護職への質問紙調査の分析から

Respect for decisions made by older adult patients in their terminal phase: an analysis of questionnaires completed by hospital nurses in Tokyo

　病院看護職による高齢患者の終末期意思の尊重の実態の認識と、関連要因を検討するため自記式質問紙調査を行い、クロス集計および相関関係分析を行った。高齢患者の終末期意思の尊重の割合は、高齢患者の意思表示のみの場合に7割強、高齢患者の終末期意思とその家族や医師の延命処置の考えが異なる場合には3〜5割程度であった。また、「終末期ケアの協働」「終末期の説明サポート」「終末期患者に関する看護」の能力が高い看護職は高齢患者の終末期の延命処置の意思の尊重の認識も高く、「終末期ケアの協働」の能力が低い看護職は高齢患者の終末期の延命処置の差し控え意思の尊重の認識が高い傾向が明らかになった。高齢患者の終末期医療の意思の尊重には、看護職に対する倫理的な教育、患者権利における倫理的な問題を解決する方法を模索する機会、本人の価値観に合わせて終末期医療に伴うケアを判断するための看護能力の必要性が示唆された。

　A self-administered questionnaire survey, cross tabulation, and correlation analysis were conducted to examine the actual conditions of hospital nurses' recognition of respect for the decisions made by older adult patients in their terminal phase and of their related factors. More than 70％ of nurses respected terminalphase decisions when only the patient's decision was presented, but this fell to between 30 and 50％ when there was a conflict between the patient's decision and the family and/or doctor's wish to provide life-support care. In addition, it was observed that nurses in a position with high capabilities for “cooperation for the care of patients in their terminal phase,” “explanatory support of the terminal phase,” and “nursing care of patients in the terminal phase” tended to respect the decisions of older adult patients requesting terminal-phase lifesupport care more, while nurses in a position with lower capabilities for “cooperation for care of patients in the terminal phase” tended to respect their decisions to refrain from terminal-phase life-support care more. To promote respect for the terminal-phase decisions of older adult patients, these findings suggest the need for the following: ethical education for the nursing profession, opportunities to search for ways to solve ethical problems regarding patients' rights, and ways for nurses to acquire the ability to make terminal care-related decisions from the viewpoint of patients that reflect the patients' values, such as the way patients live their lives and their thoughts on life.