Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a "tentative" decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were "conducting a comprehensive review of the place of death" and "embracing the wishes for a way of life without difficulty". Involving the family in making a "tentative" decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were "examining the place of death from different aspects" and "respecting the patient's intention as far as possible". Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.
We have evaluated a course delivered by videoconferencing to rural health centre staff in Hokkaido. The course focused on the planning and evaluation of community health interventions. It included four 90 min sessions and two follow-up sessions. Fourteen professional staff members (public health nurses, nutritionists and dental assistants) attended each class. Knowledge of community health-care planning and evaluation was higher at post-education testing than pre-education testing. Ratings for 'using a computer', 'using some computer software', 'using the Internet' and 'interest in telehealth' increased significantly in post-education testing compared with pre-education testing. The course had an additional benefit in increasing the collaboration between community health workers and university staff.
Elderly patients with advanced cancer and their families need to be supported in the process of making a decision about a place to die. The objective of this research was to evaluate the appropriateness and clinical applicability of a nursing intervention model we developed to support decision making by elderly advanced cancer patients and their families about the place of death. We created the Nursing Intervention Model using the framework of the nursing intervention model reported by McEvoy and Egan (1979). Our survey was performed on 5 physicians and 9 nurses engaged in decision making about the place of terminal care and death for cancer patients. Focus group interviews were conducted to determine the appropriateness of the model. A content analysis technique was used to analyze the data obtained. Survey participants expressed an overall view that the contents of “Intervention Focus” and “Nursing Activity” are generally appropriate. On the other hand, the challenges to be addressed include clarification of which patients the model is applicable to support their decision making, positioning within the model of factors that influence the decision-making process, and further identification of the roles of nurses in an interdisciplinary approach to health care.
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