Development of an effective home palliative care system

that adopts a multidisciplinary team approach

18590503

2006-2007 18-19

2008 20 5

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2001 2008

2008 5

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18 1,900,000 0 1,900,000

19 1,600,000 480,000 2,080,000

3,500,000 480,000 3,980,000

3/24

FAMCARE Scale 20

83

3.94

0.19 5 5

FAMCARE Scale

4 44

(1) (2) (3) (4) (5)

(6)FAMCARE Scale

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This study looked at the team approach to home palliative care for terminal cancer patients that

has been pioneered in the city of Okayama over the past several years (Okayama palliative care

model). This team approach involves personnel from multiple disciplines. In this study, we first

clarified the appropriate conditions for smooth implementation of the model from a qualitative

study. Then, as the final outcome, we conducted a survey of satisfaction of the bereaved families.

The conditions shown to be appropriate for smooth implementation of the model were: (1)

regular study sessions and joint conferences with the participation of both the primary care and

palliative care teams, (2) adequate sharing of information, (3) understanding by the primary team

of the special type of care provided by the palliative care team, (4) appropriate sharing of roles

between the two teams, (5) respect of the primary care team, (6) emphasis on the central role of the

visiting nurse station, (7) creation of an emergency system, (8) use of care insurance, and (9)

cooperation with welfare professionals.

In the second part of the study, we first developed an official Japanese version of the

FAMCARE Scale, which is a scale developed in Australia to survey the satisfaction of the bereaved

families. A survey form consisting of 20 items from the FAMCARE Scale was then sent to 83

surviving family members of patients who had received care under the Okayama palliative care

model. The study plan was reviewed and approved by an ethics committee. The mean score for the

survey was 3.94 ± 0.19 points (out of a possible 5). Responses of “satisfied” or better were received by

more than 50% of respondents for nearly all items. The ratings were high for “pain relief,”

“responses by medical specialists to questions,” “physicians’ response to family requests to meet and

talk,” “physicians’ attention to symptoms,” and “time taken by primary physician for patient.” A

positive assessment was made for time spent and efforts made to respond to the desires of patients’

families following the conclusion of pain control prior to home palliative care. Conversely, issues

remain in items such as “always ensuring a bed for hospitalization.” Four factors were identified in

a factor analysis of the FAMCARE Scale: “adequate amount of information,” “attitude of medical

personnel,” “education and support system for families,” and “emergency responses.” Only 44% of

respondents were satisfied with nursing care, suggesting the need for environmental

improvements to ease the burden on families. The results of this study will be useful in developing

an appropriate model for a home palliative care system using a multidisciplinary team approach.

Key words (1)Home care, (2)Palliative care, (3)Multidisciplinary team approach,

(4)Qualitative research, (5)Satisfaction of the bereaved family, (6)FAMCARE Scale

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information giving, (2) availability of care, (3) physical care,(4) psychosocial care

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2007 7 9 8 83 50 61.4%

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