日本における高齢者の終末期医療に関する家族による代理決定についての文献レビュー

Surrogate Decision-making Regarding Terminal Care for the Elderly by Family Members: A Literature Review

抄録

　本研究は，日本における家族による代理決定の研究動向と今後の研究課題について，高齢者の終末期医療に着目して明らかにすることを目的とした．検索文献のうち適合基準を満たした39文献が分析対象となった．最も古い文献の発行年は2000年で，2006年以降は毎年報告されていた．方法論は「質的研究」，研究デザインは「記述的研究」，分析方法は「質的帰納的分析」と「記述統計」，研究実施場所は「病院」がそれぞれ最も多かった．調査対象別の文献数は，「家族・遺族」群が約半数を占めた．既存研究の結果は，【代理決定に伴う家族の心情】【家族の代理決定プロセス】【家族に対する専門職の代理決定支援】【家族による代理決定に対する看護師の認識】【代理決定に対する高齢者の思考】【立場による終末期医療への意向の相違】の6つのカテゴリーに要約された．今後は，代理決定者となる家族の心理的負担の軽減に資する介入研究等への進展が期待される．

　This literature review aimed to clarify the research trends and future research issues related to the surrogate decision-making by family members in Japan by focusing on terminal care for the elderly. Thirty-nine papers matched our study objectives and were analyzed. The oldest publication was from 2000, and it has been reported annually since 2006. The most adopted methodology, research design, analysis method, and location were “qualitative research,” “descriptive research,” “qualitative inductive analysis,” “descriptive statistics,” and “hospital,” respectively. “Family and bereaved families” accounted for about half of the research participants.

　The results were summarized into the following six categories: “family's feelings toward surrogate decision-making,” “family's decision-making processes,” “support from experts during family's decision-making,” “nurses' perceptions about surrogate decisions by family members,” “elderly adults' thoughts about surrogate decision-making,” and “differences in terminal care intentions based on position.” Future interventional studies should address how to reduce the mental distress that families experience during the surrogate decision-making process.