臨牀透析 Vol.33 No.10(3)

特集名	維持透析患者の喪失感―理解・克服への支援
題名	在宅緩和ケアを通じてみた患者の喪失感
発刊年月	2017年 09月
著者	柴田岳三	緩和ケアクリニック・恵庭
【要旨】	筆者は外科医を25年，ホスピスでの緩和ケア医を9年，さらに在宅緩和ケアを標榜した訪問診療医を始めて7年が経過している．この間，多くのがん患者と向き合い，自立が失われ，残された時間が限られ，親しい人とも別れなければならないなど，多くの喪失感に苦しむ患者の姿を見てきた．しかしながら訪問診療医となって感じていることは，それほど喪失感を強く表さない患者，いや，むしろ死を積極的に受け入れようとする患者が多くなっているのではないかということである．緩和ケア技術の進歩もあろうが，在宅療養を希望する患者にはより高齢者が多いこと，入院患者より病期が進んでいる場合が多いことなどがその理由と考えられる．

Theme	Sense of loss of dialysis patients -- support for understanding and overcoming
Title	A sense of loss by patient through home palliative medicine
Author	Takemi Shibata	Kanwacare Clinic - Eniwa
[ Summary ]	The author has been practicing medicine for 25 years as a surgeon, 9 years as a palliative care doctor, and 7 years as a visiting care doctor advocating home palliative care. During this period, the author has met a number of cancer patients and also observed several patients experiencing a sense of loss related to being forced to leave from people they share a close relationship with, a loss of independence, and the anxiety associated with having limited time left in this world. However, what the author noted as a visiting care doctor was that a large number of patients do not strongly/clearly express their sense of loss or even try to willingly accept death. It may be due to the technical progress achieved in the field of palliative care, but there is a general perception that patients requesting home care are often elderly persons or patients with advanced stage disease compared to in-patients.