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The frequency of doctor home-visits was the only factor identified that was positively associated with the occurrence of home death in home medical care settings.

Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

No abstract

Aim Home medical care is currently a topic of discussion in Japan. It is reported that the key to the success of home medical care is communication. The aim of the present study was to elucidate the characteristics of communication during home medical care of patients with intractable neurological diseases (IND patients) by comparing them with patients with malignant tumors, the representative common disease for home medical care. Methods A questionnaire survey was sent out in June and July 2011 to 295 families of patients who had previously received home medical care. The response rate was 83.8% (n = 227). Communication backgrounds were compared between those patients whose primary disease was either IND or malignant tumor. Results Analysis of responses from 104 families (IND, 30 and malignant tumors, 74). was undertaken The number of families that experienced “doctor‐patient communication without family” was 15% (n = 4) in the IND group and 35% (n = 24) in the malignant tumor group (P < 0.05). The number of families who had experienced “doctor‐family communication without patient” was 44% (n = 12) in the IND group and 83% (n = 54) in the malignant tumor group (P < 0.01). No statistically significant differences in doctors' stay duration were observed. Conclusion It is suggested that communication with the patient in the presence of their family is characteristic of communication during home medical care of IND patients, because this was observed to be more frequent than that for malignant tumor patients.