Development of an effective home palliative care system that adopts a multidisciplinary team approach

这项研究着眼于过去几年在冈山开创的为晚期癌症患者提供家庭姑息治疗的团队方法（冈山姑息治疗模式），这种团队方法涉及来自多个学科的人员。在本研究中，我们首先从定性研究中明确了模型顺利实施的适当条件。然后，作为最终结果，我们进行了一项对遇难者家属满意度的调查。第一次定性研究的结果是：(1)初级护理和姑息治疗团队共同参与的定期学习会议和联合会议，(2)充分共享信息，(3)初级护理团队了解姑息治疗团队提供的特殊类型CAM，(4)两个团队之间适当的角色共享，(5)尊重初级护理团队，(6)强调访问护士站的核心作用，(7)建立应急系统，(8)使用护理保险，(9)与福利专业人士合作。接下来，我们首先开发了日本官方版的FAMCARE量表，这是一个调查丧亲家属满意度的量表。调查问卷被发送给83名在冈山模式下接受治疗的患者的幸存家属。此次调查的平均得分为3.94分（满分为5分）。超过50%的受访者对几乎所有项目的回答都是“满意”或“更好”。在医学专家对问题的“缓解疼痛”反应、“医生对家属要求见面和交谈的反应”、“医生对症状的关注”和“主治医生为病人所花的时间”等方面，评分都很高。相反，在诸如“始终确保住院床位”之类的项目中仍然存在问题。只有44%的受访者对护理感到满意，这表明需要改善环境以减轻家庭负担。

This study looked at the team approach to home palliative care for terminal cancer patients that has been pioneered in 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 results of the first qualitative study 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 cam 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.Next, we first developed an official Japanese version of the FAMCARE Scale, which is a scale developed to survey the satisfaction of the bereaved families. The questionnaire was sent to 83 surviving family members of patients who had received care under the Okayama model. The mean score for the survey was 3.94 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." Conversely, issues remain in items such as "always ensuring a bed for hospitalization." Only 44% of respondents were satisfied with nursing care, suggesting the need for environmental improvements to ease the burden on families.