入院中末期がん患者の在宅療養移行の検討に関連する要因を明らかにした全国調査

Assessment of Factors Related to Consideration of Transfer of Terminal Cancer Inpatients to a Home Care Setting：A Nationwide Survey

要旨

　本研究では，入院中の末期がん患者の在宅療養移行の推進を目指し，患者の在宅療養移行の検討・非検討と，患者・家族要因，看護師要因，および病院・病棟要因の3側面との関連を調べる全国調査を実施した．全国の53病院82病棟において，末期がん患者を受持つ病棟看護師464名に対する質問紙郵送調査を行い，患者の在宅療養移行の検討に関連する要因をロジスティック回帰分析にて分析した．その結果，患者・家族要因として，患者あるいは家族の在宅療養の希望があること，患者の入院期間が長く，酸素療法を行っていないこと，およびモルヒネ投与方法が経口であること，さらに，看護師要因として，在宅ケアに関して同僚による助言を受けた経験があり，患者のインフォームドコンセントを促すための情報提供を積極的に行っている看護師が受持ちであることの計7項目が関連要因として示された．今後，本研究にて明らかにされた各要因を重視した環境整備が望まれる．

Abstract

　Aiming at increasing the number of inpatients with terminally ill cancer to move home and receive home care, a nationwide survey was conducted to clarify factors for nurses in charge to consider of receiving home care on the inpatients with incurable cancer. Data were obtained using a questionnaire, which investigates the demographic and situational characteristics on the patient and family caregiver, in addition to the characteristics of the nurse in charge, the care unit, and the hospital. The correlated factors on the nurse's consideration of her patient's transfer to a home care setting were examined by a logistic regression analysis. Analyzed on the data of 464 cancer patients in 82 care units from 53 hospitals, seven factors were clarified, that is, patients and/or family caregivers having desire to transfer a home care setting, patients receiving longer terminal care on the unit, not receiving an oxygen therapy, being controlled pain by using morphine by mouth, nurses in charge consulting her superiors on receiving home care of her patients, and nurses vigorous submission of information to obtain the informed consent of patients. Our results may help healthcare professionals to plan the appropriate nursing support for more terminally ill cancer inpatients to receive home care.