Respect for decisions made by older adult patients in their terminal phase: an analysis of questionnaires completed by hospital nurses in Tokyo

Abstract

A self-administered questionnaire survey, cross tabulation, and correlation analysis were conducted to examine the actual conditions of hospital nurses’ recognition of respect for the decisions made by older adult patients in their terminal phase and of their related factors. More than 70％ of nurses respected terminal-phase decisions when only the patient’s decision was presented, but this fell to between 30 and 50％ when there was a conflict between the patient’s decision and the family and/or doctor’s wish to provide life-support care. In addition, it was observed that nurses in a position with high capabilities for “cooperation for the care of patients in their terminal phase,” “explanatory support of the terminal phase,” and “nursing care of patients in the terminal phase” tended to respect the decisions of older adult patients requesting terminal-phase life-support care more, while nurses in a position with lower capabilities for “cooperation for care of patients in the terminal phase” tended to respect their decisions to refrain from terminal-phase life-support care more. To promote respect for the terminal-phase decisions of older adult patients, these findings suggest the need for the following: ethical education for the nursing profession, opportunities to search for ways to solve ethical problems regarding patients’ rights, and ways for nurses to acquire the ability to make terminal care-related decisions from the viewpoint of patients that reflect the patients’ values, such as the way patients live their lives and their thoughts on life.