臨牀透析 Vol.25 No.10(10)


特集名 終末期にある透析患者への対応
題名 透析患者は終末期をどのように捉えているか
発刊年月 2009年 09月
著者 杉澤 秀博 桜美林大学大学院老年学専攻
【 要旨 】 本稿では,透析患者の終末期に対する意識や態度として次の点を明らかにした.(1) 透析患者の間では死や終末期の透析についてあまり考えていないという人が31%いた.その背景には,死を「否認する」といった心理的なメカニズムが働いていた.(2) 終末期ケアについて自分の考えを周囲に伝えている人は少なく,その理由には,「家族への負担の軽減」「決定しても守られないという無力感」「家族への依存的態度」「死をタブー視する態度」があった.(3) 重度認知症やがん末期については,「差し控える」「継続する」「わからない」がほぼ同じ割合で存在していた.差し控えるという意向には,「家族への精神的・身体的負担の軽減」といった意識が影響していた.
Theme How to Correspond to Chronic Dialysis Patients in End-of-Life Stage
Title Attitudes toward end of life in hemodialysis patients
Author Hidehiro Sugisawa J.F. Oberlin University Graduate School, Program in Gerontology
[ Summary ] The purpose of this article is to describe attitudes toward end of life in hemodialysis patients by using a qualitative and quantitative survey. The results were summarized as follows; 1) 31% of the patients had not thought about their terminal care. They may have tried to avoid thinking about terminal care to avoid their fear of death. 2) The reasons why the patients had not talked about terminal care to their families were related to factors such as avoidance of conflict with their family's decisions concerning terminal care, an inclinationto entrust decision related to terminal care to family members, and feeling of powerlessness that arose from noncompliance with decisions made by their families. 3) In relation to hemodialysis in the end stages of dementia or cancer, those respondents who answered 'withholding', 'keeping', or 'don't know' accounted for almost equal percentages of those surveyed. The choice of whether or not to with hold hemodialysis was related to theability to reduce the burdens on their families interms of providing care.
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