日本の在宅看取りに関する論文の現状と実態のスコーピングレビュー：奈良県内の看取りのあり方の検討をめざして

Abstract

本研究の目的は，日本国内の看取りの研究の現状と課題を明らかにして，奈良県内の看取りのあり方を探究する資料とすることである。研究方法は，スコーピングレビューを用いた。Patient (P) :在宅(療養者)死， Concept (C) :ケアの内容，現状と実態， Context (C) :日本，看取りとして， PCCのフレームワークを用いた。使用したデータベースは，医学中央雑誌であった。一次スクリーニングで抽出された論文をスコーピングレビューチームで精読し採用論文を決定した。結果，一次スクリーニングでは8件，二次スクリーニングでは4件採択された。へき地に暮らす高齢者は困りごととして話す人はいなかった。死亡場所確認および予後説明があると意思決定支援につながることがわかった。看取り件数が多くなると訪問看護師の満足度は低くなるが，介護職で、は高い結果であった。訪問看護師の肯定的感情を高めることがモチベーションの維持向上になり，看取り支援の質向上へとつながる可能性が示唆された。

The purpose of this study was to clarify the current status and issues of research on end-of-life care in Japan，and to provide material for exploring the state of end-of-life care in Nara Prefecture. A scoping review was conducted using electronic databases including the Central Journal of Medicine. The PCC framework was used. The keywords were Patient (p): death at home (caregiver)，Concept (C): content of care，current status and actual conditions，and Context (C): Japan，and end-of-life care. The PRISMA statement (the Preferred Reporting Items for Systematic Review) was also consulted. We selected papers from the primary screening process for inclusion in the scoping review team. In accordance with the research question (RQ),the scoping review team conducted a close reading of the literature extracted from the primary screening. In secondary screening， the selected papers in the primary screening were carefully read by the scoping review team. In addition，the literature was examined for its suitability for the RQ. As a result，eight papers were selected in the primary screening and four papers were selected in the secondary screening. None of the elderly people living in remote areas talked about living there as a problem. It was found that confirmation of the place of death and explanation of the prognosis helped to support the person's decision-making. Satisfaction was lower among home care nurses as the number of end-of-life care cases increased，but was higher among caregivers. It was suggested that higher positive emotions among home care nurses may help them maintain their motivation and improve the quality of end-of-life care.