Factors that Influence the Decision Maker regarding End-of-life Care

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  • Iwabuchi Masahiro
    School of Nursing, Yokohama Soei University,
  • Sato Kazuki
    Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine,
  • Miyashita Mitsunori
    Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine,
  • Morita Tatsuya
    Palliative and Supportive Care Division, Seirei Mikatahara General Hospital,
  • Kinoshita Hiroya
    Department of Palliative Medicine, National Cancer Center Hospital, East

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  • 終末期医療を患者・家族・医師の誰が主体となって決定したかについての関連要因と主体の違いによる受ける医療やQuality of Lifeへの影響の検討

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Objectives: To determine the factors that influence the decision maker regarding end-of-life (EOL) care and to disclose how aggressive care in the last week before death, place of death, and quality-of-life (QOL) affected the decisions made. Methods: The subjects were 409 bereaved family members (cause of death included cancer, stroke, heart disease, and pneumonia) that registered with an internet research agency. Decision-making was controlled either by the patient, family, or physician or shared by the patient, family, and physician. Results: The results of a multinomial logistic regression analysis demonstrated that when a family controlled decision-making, they were less likely to report patient-family EOL discussion [odds ratio (OR)=0.52], and that the patient had good communication with the physician (OR=0.77); they were also likely to report that the patient had dementia (OR=1.94). Families who reported physician-controlled decision-making (vs patient controlled) were less likely to report that the patient had good communication with the physician (OR=0.62). Cardiopulmonary resuscitation in the last week and place of death were not associated with the decision maker. EOL QOL was associated with EOL care of the decision maker. When a physician controlled decision-making, patient EOL QOL was at its lowest. Conclusion: To improve patient-controlled decision-making, it is critical that patients, families, and physicians have more communication regarding EOL care.

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