2018 Volume 19 Issue 3 Pages 145-150
In Japan, about half of the citizens wish to die at home, but the majority of deaths occur in hospitals. The proportion of hospital death by cancer is especially high. If cancer patients wish to be cared for and die at home, it is important to realize their wishes. In this study, focusing on the presence or absence of home medical care before hospitalization, we examine measures to realize continuation of medical care and death at home by clarifying differences in treatment contents and period from hospitalization to death. With a retrospective cohort study design, we used the data derived from the Japanese administrative database and diagnosis procedure combination (DPC) database. In this study, 11,876 end stage pancreatic cancer cases were included. We compared differences in treatment contents and period from hospitalization to death by presence or absence of home medical care before hospitalization. As a result, patients who had home medical care before hospitalization had lower percentage of life-prolonging treatments such as cardiopulmonary resuscitation and active treatment such as chemotherapy. Also, patients who had home medical care had shorter days between hospitalization and death. Based on these results, it was considered that patients who had home medical care before hospitalization had decided beforehand not to be treated with life-prolonging treatment and active treatment. Also, it was considered that patients who had home medical care ware taken to the hospital and had died relatively soon after staying at home until just before the life crisis. If cancer patients wanted to be treated or to die at home, it was considered important to eliminate the anxiety concerning medical care of patients, and that of patients' families, to avoid hospitalization. To that end, it was considered important for medical staff to implement early palliative care and to carefully explain the condition to patients and their families.
