Survey on Users with Cancer at Nursing Care Insurance Facilities

-- On the actual conditions of decision-making at the time of and after shifting to palliative care --

Abstract

The present study aimed to elucidate the actual conditions of decision-making at the time when the users with cancer at nursing care insurance facilities changed to palliative care and after the change took place.
We conducted a semi-structured interview of 10 nursing care staff with experience in providing care to such users at one of the three nursing care insurance facilities from December 2012 to November 2013. After obtaining informed consent from the participants, we recorded the contents of the interview, prepared a verbatim report, and conducted a content analysis.
In the interview, all subjects talked about their experiences of end-of-life care for these users who shifted to the palliative care. It was found that even specific information such as the name of the disease was not given to the patient and that decisions for users with cancer were made in accordance with the intent their families. Further, the family was more concerned about dementia rather than the treatment of the disease, and as the family became pessimistic about improvement of the user's condition, they preferred a natural death rather than depending on the medical treatment."
Decision-making of such users seemed to be influenced by the preconceived notions of their families toward aging and dementia. It was found that surrogate decision making by the family regarding treatment was characteristic of users of nursing care insurance facilities.